Ed Brayton is a journalist, commentator and speaker. He is the co-founder and president of 
Nancy Pelosi insists that the election of Scott Brown to the Senate from Massachusetts will not stop health care reform from getting passed, but that may well be wishful thinking. A number of different dynamics unleashed by his election are going to make it very difficult to get a final bill passed in both houses. There are three possibilities for getting it done now:
1. Have the House pass the Senate version of the bill, which would make it immediately into law and skip over the conferencing process, sending the bill directly to the president's desk.
But is the House really going to pass that bill? Not likely. For one thing, this monumental upset has some Democrats, especially ones from more conservative states, rethinking their support for health care reform out of fear of losing in November. Politico reports on some of those Democrats:
The White House's preferred option is for the House to approve the already-passed Senate version of health reform, to avoid the need for another vote in the Senate. But several House members said last night they're not prepared to pass the Senate bill alone - even if it means health care reform would die.In fact, early signs of split emerged as the polls closed in Massachusetts - between leaders like House Majority Leader Steny Hoyer who said "the Senate bill is better than nothing," and individual members who refused to swallow the Senate's version of health reform whole.
And with the winning majority for a health reform bill in the House so thin, almost any defections at this point would be fatal to reform's prospects.
"I've maintained for months now that incremental reform in the health care package would make much more sense from my perspective," said California Rep. Jim Costa, one of the last Democrats to vote "yes" on the House bill.
He said he'd like to see Obama tell voters that "we may have been overreaching" and then push for a scaled-back bill that focuses on things more people can agree on, like insurance reforms. He said it's not just a question of the House bill versus the Senate bill. "For me, it's broader than that," Costa said.
Rep. Anthony Weiner (D-N.Y.), one of the leading advocates for health reform in the House, urged fellow Democrats to heed the message of Massachusetts and pivot toward creating jobs, perhaps with a health-care component added in...
Rep. Brad Ellsworth (D-Ind.) said, "We were fully expecting to go some kind of conference committee and work out those differences [with the Senate]. And there are still differences to work out. I cannot imagine, from one person, one member from Indiana, that this House would accept the Senate bill as is."
2. Rush to get the bill through before Brown is sworn in.
Again, this is becoming less and less likely. Jim Webb has already registered his sentiment that a final vote should be put off until Brown takes his seat:
Webb wrote in a statement: "It is vital that we restore the respect of the American people in our system of government and in our leaders. To that end, I believe it would only be fair and prudent that we suspend further votes on health care legislation until Senator-elect Brown is seated."And he likely will not be alone in the Senate; other moderate Dems may take the same position and are looking for a slowdown to the process to evaluate the political fallout:
And in the Senate, two moderates, Democrat Evan Bayh of Indiana and Independent Joe Lieberman of Connecticut, separately raised concerns Tuesday about the direction of the Democrats' agenda, with Bayh saying he feared the Democrats' policy plans had gone too far to the left."It's why moderates and independents even in a state as Democratic as Massachusetts just aren't buying our message," he told ABC News. "They just don't believe the answers we are currently proposing are solving their problems. That's something that has to be corrected."
Heck, even Barney Frank says he won't vote for the bill under those circumstances:
Massachusetts Rep. Barney Frank, a strong supporter of the health care legislation, said Brown's victory means Congress will have to "start over on health care." He said he will vote against any bill rushed to the floor before Brown can be sworn in.If you can't get Barney Frank's vote that way, you're going to lose a lot of other votes as well.
3. Try to pass the bill under reconciliation rules.
But as Lawrence O'Donnell, who understands the Senate rules better than almost anyone else, pointed out on MSNBC last night, there are numerous procedural votes within the reconciliation process that require 60 votes, which the Republicans will undoubtedly use to prevent a final vote.
Is health care reform dead? At the very least, it's on life support.
Politics
Comments
Bayh saying he feared the Democrats' policy plans had gone too far to the left.
Too far left? you start with proposals already to the right of the situation in similar nations then water them down to meet conservative criticism and this is too far left?
Posted by: Matty | January 21, 2010 9:23 AM
Is it not a good thing that it's close to dead? Face it, any horror story that aries in the near future will be blamed on this bill. I'd like to think that if it didn't pass that in the future when people are getting shafted by insurance companies they'd get reminded of the republican alternative.
Posted by: Naughtius Maximus | January 21, 2010 9:25 AM
I'm curious about something and would like to hear the responses of this blog's liberals. Assuming that the public option is dead in the water, and the only bill likely to pass is the Senate version that requires people to buy health insurance, is it better to let it die, or better to pass the Senate version?
I can see alternative arguments here. One is that the bill is so bad in its requirement to force people to buy health insurance--which is basically a gift to the insurance industry--that it's anti-liberal and should be killed. The other is that the bill contains some other elements that are good enough so that on balance it's a net positive, and at least then the camel's nose is under the tent, and it can be improved in the future (policymaking does, after all, tend to be incrementalist).
Thoughts?
Posted by: James Hanley | January 21, 2010 9:32 AM
The way to win and keep public support for a bill is, first and foremost, to write a good bill, and one that the general public can understand. The Democrats in Congress did neither.
Once the decision was made to let Sen. Lieberman and Sen. Nelson recraft the bill as they wished to win their votes, the result was all but inevitable: a Rube-Goldberg jerry-rigged complex mess that (a) the general public does not understand --- I certainly don't, and (b) a bill far from what a thumping 60% of the nation polled favoring on election day.
Had the Democrats crafted and sent to the floor a bill that established, clearly, a public health care option that didn't look like the dog's breakfast vomited up [a convoluted opaque steaming mess], they'd have been in good shape even if the Republicans in the Senate had filibustered it successfully. The onus would have been on them then in the coming election.
When your idea of "health care reform" turns out to be such a convoluted mess that won't do what most Americans thought "health care reform" by Democrats would do, you end up losing. Big time. And that's what happened. And will happen again in November.
Posted by: flatlander100 | January 21, 2010 9:36 AM
People are already getting shafted by insurance companies. And, most of the public already supports "reform". And yet plenty of people continue to support Republicans in spite of it. Letting this bill die probably won't create much of a drop in support for Republicans, because that would just maintain the status quo.
Posted by: catgirl | January 21, 2010 9:41 AM
James Hanley: At this point, the situation is simple. Health care reform passes. Or the Democrats never see the inside of a government building again. The national narrative is that the Democrats had so much power and couldn't accomplish anything. The Party of No meme has failed to impress. So letting the bill die and handing the nation over to Republicans
I think that's what Nancy Pelosi is going to do. Walk up to each Rep and say, "If this bill fails, you're finished. If it succeeds, you at least have a chance. Martha Coakley only lost because she was terrible candidate." Not to mention all the Democrat Reps who voted down the first bill because it was too liberal. I'm optimistic it'll still happen.
Posted by: Brandon | January 21, 2010 9:42 AM
"I'd like to think that if it didn't pass that in the future when people are getting shafted by insurance companies they'd get reminded of the republican alternative."
I think you overestimate the public's memory. Aside from that, how long will it be before significant reform is seriously considered again? To me, even marginal improvement seems more worthwhile than a weaksauce party winning some brownie points.
Posted by: Treppenwitz | January 21, 2010 9:47 AM
catgirl
I'm sure people are getting shafted, and do you know who more than likely will get shafted in the future, those morons that went around screaming at meetings.
Treppenwitz
But making people buy into what most people think is part of the problem isn't a good step.
Basically, at the end of the day isn't the problem that peoples health is becoming a commodity?
Posted by: Naughtius Maximus | January 21, 2010 9:54 AM
flatlander100
Spot on. Without buying states like LA or NE or the unions. Just a straightforward bill. At least then you can discover whether the public is against the concept (which polls suggest they are not), or just against the shameless deals and pandering.
Will it happen? When
a Republican wins the Kennedy senate seat.pigs fly. But maybe with the magic 60 out of the question things will be more sensible.And maybe the Pirates will be in the next World Series.
Posted by: heddle | January 21, 2010 9:57 AM
A number of different dynamics unleashed by his election are going to make it very difficult to get a final bill passed in both houses.
One of those dynamics is that the Democrats are already starting to cave, and are announcing this fact as policy. Pelosi gave a solemn speech about how the Democrats are listening to the voters in MA and "going forward" with solemn acknowledgement of MA's clear message. Translation: they're already collapsing in defeat even though they're still the majority party.
It's time for an insurgency in the Democratic primaries.
Posted by: Raging Bee | January 21, 2010 9:59 AM
Brandon wrote:
There's a difference between simple and so overly simplistic as to be utterly ridiculous.
Posted by: Ed Brayton | January 21, 2010 10:02 AM
Posted by: william e emba | January 21, 2010 10:03 AM
How can it be that people with an attention span so famously short are going to "remember" this stuff in November?
Posted by: jws | January 21, 2010 10:10 AM
So many commentators say that the Dems have moved too far to the left. I think they've gone so far to the right that they've lost the passion and any distinguishing traits from the Repubs. I'd much rather see them regroup on their core principals (or to even articulate some core principals, the spineless dweebs!) and go hard left. Sure they may lose but I think it's more likely that they could awaken something powerful which could make them stronger.
Doing this middle-of-the-road playing defence crap may make some sense if they're badly outnumbered but when they have a big majority? What a joke.
Posted by: Tyro | January 21, 2010 10:10 AM
the GOP are a bunch of vicious assholes uninterested in governing. The Dems are a bunch of ball-less wonders who can't govern. I want to move to Australia where I don't give a shit about their politics.
Posted by: Susan Brassfield Cogan | January 21, 2010 10:16 AM
The democrats fucked up big this time. They should have gone reconciliation from the get go. We'd have had good legislation by now, instead of a shitty bill that will never pass. One thing that pisses me off more than anything is how the number of people who don't like this health care bill is reported by the media. It's now 54%. But of that number, how many are republicans who never wanted any in the first place, and how many are progressives that don't think it goes far enough? I know I'm part of the latter group.
Posted by: Robert Faber | January 21, 2010 10:23 AM
Sure they may lose but I think it's more likely that they could awaken something powerful which could make them stronger.
And if they do it right, their loss would only be temporary -- if they actually lose at all.
Doing this middle-of-the-road playing defence crap may make some sense if they're badly outnumbered but when they have a big majority? What a joke.
It doesn't make sense in either case (which is why the Republicans never did it): when they're outnumbered, they have to take control of the debate, offer real alternatives, pick fights, and attack the majority party when they fail. And when they're the majority, of course, they have to use their power and get things done.
And even when "this middle-of-the-road playing defence crap" is necessary, the Democrats are doing it wrong: by announcing their willingness to "compromise" before the fight even starts, they embolden their enemies to push all the harder, thus ensuring that the result is capitulation, not compromise.
Reagan made his share of compromises; but he did so from an initial position of hard-right hard-ass posturing, which ensured he got the better half of every deal he made. The Democrats can't even do lame-ass compromise right.
Posted by: Raging Bee | January 21, 2010 10:24 AM
Nah, many of those screaming people have already been shafted. But they still oppose health care reform for two reasons:
1) They're willing to suffer themselves to make sure that that the "wrong" people don't get help that they don't deserve. Racism may be small part of it, but it goes far beyond that. The thought of some Other getting health care through taxpayer money fills them with rage. (Of course, they don't realize that this already happens because we're not barbaric enough to turn a dying person away from an ER, and that we'd probably save money in the long run for just paying for it up front).
2) Plenty of people have already convinced them that their health care really is good, even though their grandma died because her insurance would pay for cancer treatment or their kid's autism won't be treated because it's a "pre-existing condition". But there are so many horror stories from other countries (which are often made-up or exaggerated) that these people ignore the statistics and really believe that our crappy system is the best we can hope for. Then there's the patriotic angle where you're not a Real American(TM) if you admit that our health care system isn't super-duper perfect, and also Hitler wanted to give people health care, etc., so Granny's death really isn't so bad because it would be a whole lot worse under any other system. They don't see themselves as benefiting from health care reform; they only think about the undeserving Others who will benefit while they pay slightly more in taxes.
Posted by: catgirl | January 21, 2010 10:31 AM
This pretty well summarizes the American political landscape. Given our options, voting pretty much always involves suppressing the urge to vomit.
Posted by: Treppenwitz | January 21, 2010 10:31 AM
Susan Brassfield Cogan - let me tell you a little about Australia politics:
The Liberal/National coalition (in opposition) is a bunch of vicious assholes uninterested in governing, and the Labor Government are a bunch of ball-less wonders who can't govern.
I suggest a nice island in the Pacific: population (inclusive of your good self), one. - Dingo
Posted by: DingoJack | January 21, 2010 10:42 AM
Okay, I didn't mean that literally. But I do believe that if the bill doesn't pass, the Republicans will win in a landslide in 2010. And Obama will be at a huge disadvantage in 2012 unless he achieves some tangible accomplishment that can be wrapped up into a three word sound bite.
And even if that is overly simplistic, it's what Pelosi needs to be telling Reps who are having doubts about the bill.
Posted by: Brandon | January 21, 2010 10:43 AM
Nail on head, catgirl. People aren't afraid of death panels or government bureaucrats. They're afraid of their tax dollars going to welfare queens and their sick children.
Posted by: Brandon | January 21, 2010 10:47 AM
From what I understand of the Senate version of the bill is that I will pay more, get less and have no alternatives. If I'm wrong in my opinion, blame it on the Democrats in Congress and the Democrat in the White House for not being able to clearly articulate just what they are up to.
The Democrats are such poor communicators they can't even defeat the idiotic idea that closing Gitmo and locking them up in prisons here would lead to terrorists walking freely on main street.
We are the ones we've been waiting for indeed.
Posted by: Owen | January 21, 2010 10:50 AM
@Owen:
As I understand, the only option you would lose is the option not to insure yourself. Also, I don't see any provision forcing you to pay more, unless you already lack coverage and need to go buy some. But that's only if you don't have coverage AND can afford it. If you can't afford it, you'll get a subsidy and have to pay little or nothing.
The question of whether or not you should support health care reform comes down to this: should access to care be the responsibility of the individual or of society? If you think our society will be better off providing health care for anyone who needs it, then this bill probably deserves your support even with its several flaws (such as pretty much guaranteeing the current health insurance companies larger profits for no extra work or benefits). If you think it should be the responsibility of the individual, then this bill is not for you.
It will probably have a number of benefits you won't see in the stats; for example, large cohorts of uninsured use hospital emergency departments for primary care, and the losses the hospitals take on the non-payers get written into everyone else's bills. Hypothetically, with more universal coverage hospitals will lose less money on their emergency departments and be able to lower prices and increase quality of care.
@James Hanley:
I don't necessarily consider myself a liberal, but I would defend the current bill if I were convinced that access to health care should be a responsibility of our society rather than individuals (I'm not convinced). The mandate is an absolutely necessary part of any such legislation, since otherwise there is no incentive for healthy young people to pay into a system that will mostly pay out to retirees. Social insurance depends on the secure population cohorts putting up some money to help out everyone else, and if these "loans" aren't mandated, then it's really charity and not social insurance in the first place.
Posted by: Dan L. | January 21, 2010 11:21 AM
This liberal's reply to James Hanley:
It's the Will Rogers moment for the House Democrats - and they'll probably once again prove that they are not members of any organized political party. If they were, they would pinch their noses and vote for the Senate bill. It is the only rational action both on substantive and on strategic grounds. But they will almost certainly be paralyzed by the combination of ego and stupidity and will waste the once-in-a-couple-of-decades opportunity, thus squandering their party's majorities and eventually the presidency.
As I've been saying a lot lately - the two major political parties in this country are the Chickenhawk Party and the Chickenshit Party.
Posted by: bullfighter | January 21, 2010 12:25 PM
What a load of shit:
Flatlander: "The way to win and keep public support for a bill is, first and foremost, to write a good bill, and one that the general public can understand."
heddle: "Spot on. Without buying states like LA or NE or the unions. Just a straightforward bill. At least then you can discover whether the public is against the concept (which polls suggest they are not), or just against the shameless deals and pandering."
Have you ever read any law, let alone one dealing with something as complex as the health care system? There is no such thing as a "straightforward bill" that "the general public can understand". If a bill's complexity is a problem, then we have long become unable to govern ourselves and we need a colonial power to take over us.
Posted by: bullfighter | January 21, 2010 12:32 PM
You think the American right-wing is bad, I interact with a lot of military medical personnel and they'll go on and on and on about how government health care workers are lazy idiots incapable of getting work in the real world.
Worse part of it, many of them are reservists, meaning they're civilian health care providers most of the time. Do they slack off when serving our soldiers, or they unaware that the Army or Air Force are run by the government. The mind boogles.
Posted by: History Punk | January 21, 2010 12:33 PM
Can Obama circumvent Congress by simply making an executive order that the Medicare program will now cover all ages?
It is, after all, a Federal agency and all he would be doing is mandating a simple policy change, something which I think ( emphasis on think ) Presidents have done all the time.
Posted by: Gingerbaker | January 21, 2010 12:41 PM
Owen:
Why do you have to blame your own stupidity on somebody else?Posted by: bullfighter | January 21, 2010 12:44 PM
bullfighter,
Why, because you say so? Sorry, not convinced. Are you saying the a Health Care Bill must contain language regarding, for example, "states that in the preceding seven years have been declared major disaster areas"? That it has to ~2000 pages?
I don't think so although maybe I'm wrong. But your assertion does not demonstrate my error because your assertion is just that; it is not an argument.
And yes, as a member of the general public, I have read many laws and have, at least at a working level, understood what I read.
Posted by: heddle | January 21, 2010 12:45 PM
gingerbaker:
Why stop at that? Can't he just shoot all the Republicans in Congress? (The shorter answer is no, it would be kinda illegal.)Posted by: bullfighter | January 21, 2010 12:48 PM
bullfighter,
By the way have you read any laws and understood them, and if yes then by your own thesis you must not be a member of the general public--so what are you? A member of congress? A judge?
Or are you exempt from your own assertion because you are somehow "special"?
Posted by: heddle | January 21, 2010 12:49 PM
Heddle: "your assertion does not demonstrate my error because your assertion is just that; it is not an argument."
While your assertion was backed by evidence? Give me a break and flush after you post.
Posted by: bullfighter | January 21, 2010 12:51 PM
Oh, no! More shit from heddle! This is officially diarrhea:
"By the way have you read any laws and understood them"
Yes. More of them than I'd like.
"and if yes then by your own thesis you must not be a member of the general public"
Logic FAIL. Correct implication is that I am not close to the median member of the general public.
"Or are you exempt from your own assertion because you are somehow "special"?"
I'm smart and literate. It's nothing special in the circles in which I normally communicate (my work, my family and friends, and even the parts of the blogosphere I tend to visit), but, unfortunately, it is indeed "special" (i.e., unusual) in the general public, such as among a random sample of voters.
Posted by: bullfighter | January 21, 2010 12:58 PM
Not enough votes
http://news.yahoo.com/s/ap/20100121/ap_on_bi_ge/us_health_care_overhaul
Posted by: Naughtius Maximus | January 21, 2010 1:15 PM
Naughtius Maximus, that is very depressing news. And it really pisses me off when Republicans talk about working together and bipartisanship, as if it weren't a code phrase to, "We jerk off to seeing Obama fail."
Posted by: Brandon | January 21, 2010 1:23 PM
bullfighter,
Which of course is not what flatlander implied or at least not what I inferred. It was not: write a bill that anyone can read-- that a person chosen at random can read. It was not a lowest common denominator demand. It meant by "general public" (flatlander can correct me if I am wrong) that your average person who had the inclination to read the bill could in principle understand it.
I see you have a high opinion of yourself. Whether it is warranted I couldn't say. But relative to that group that I think flatlander meant, and certainly the group I meant, I see no evidence that you are special.
Posted by: heddle | January 21, 2010 1:26 PM
I agree with bullfighter: you CANNOT write a law the "general public" can be expected to understand. Policy and enforcement issues will always get complex, there will always be a need to compensate for exceptional cases, regional variations, wildly varying circumstances, etc. etc.; specific legalese and terms-of-the-trade will have to be consistently used to express very specific concepts correctly; and there will always be a devil of some sort in the details; and if you don't address details, then your law will be so vague as to be meaningless and wide open to abuse. ESPECIALLY in an area as complex as public health-care policy. If you think complex laws suck, take a look at the simple ones written by self-righteous laymen as "initiatives." That thing in the Constitution about "vague" laws is there for a reason.
Are you saying the a Health Care Bill must contain language regarding, for example, "states that in the preceding seven years have been declared major disaster areas"? That it has to ~2000 pages?
Well, why don't you go through the bill and use your understanding of the relevant issues (health-care, fiscal policy, bureaucratic organization, medicine, and of course, law) to tell us which complex bits we can dispense with and why? (And no, bitching about the number of pages says absolutely nothing useful; it's just another shrieking-point for people who want the Bible to be their only law, and can't even understand that.)
If a bill's complexity is a problem, then we have long become unable to govern ourselves and we need a colonial power to take over us.
And then we'd be bitching about the complexity of laws written in a FOREIGN LANGUAGE (Chinese?).
Posted by: Raging Bee | January 21, 2010 1:30 PM
Diarrhea patient:
Which of course is not what flatlander implied or at least not what I inferred.
Of course. Except for the petty detail that it's exactly and unambiguously what flatlander wrote.
that your average person who had the inclination to read the bill could in principle understand it
A typical person actually inclined to read legislative bills (as evidenced by having in fact read some) can understand this one just fine.
relative to that group that I think flatlander meant, and certainly the group I meant, I see no evidence that you are special
By contrast, I see evidence that you are special among Ed's frequent commenters. Most of them are not idiots.
Posted by: bullfighter | January 21, 2010 1:34 PM
Raging Bee,
On a scale of 1 to a typical WorldNutDaily editorial, that's an 11. There is simply no causal connection or correlation between "bitching about the number of pages" and "people who want the Bible to be their only law." Absurd.
I'm guessing that we are in agreement that you are not a member of the general public, but "special" like bullfighter.
Posted by: heddle | January 21, 2010 1:39 PM
I am neither stupid nor am I in the habit of blaming others. It is not too much to expect those who have chosen to run for office and lead to clearly communicate what they intend to do.
Unlike you, most of us do not live in our mother's basement and have other responsibilities that prevent us from volumes of documents required to understand the legislation.
Posted by: Owen | January 21, 2010 2:08 PM
I am shocked - SHOCKED - that the stupid outnumber the smart!
Posted by: bullfighter Renault | January 21, 2010 2:18 PM
It is not too much to expect those who have chosen to run for office and lead to clearly communicate what they intend to do.
Actually, in the case of health-care-reform legislation, it is, for the not-so-simple reason that this legislation will, of necessity, be a patchwork political compromise between competing and sometimes hostile interest-groups, not the work of one author or one coherent interest-group. There WILL be complications and ambiguities, at least until a more solid public concensus forms and gives us a clearer bill.
Also, I suspect that for most Americans, the problem isn't "too complicated to understand," it's "too much to read in the free time we have." Break it down into more digestible bites, and each bite will, for the most part, be easy to understand in itself, give or take some long convoluted sentences and multiple clauses and sub-clauses.
Posted by: Raging Bee | January 21, 2010 2:21 PM
Brandon:
People aren't afraid of death panels or government bureaucrats. They're afraid of their tax dollars going to welfare queens and their sick children.
Conservative "paleocon" Steve Sailer actually favors the US moving to a single-payer publicly supported healthcare system. Granted, he also favors eliminating welfare, WIC/food stamps, and Social Security. His reasoning is that it's better to replace current government programs that give people "perverse incentives" not to work and that keep them dependent on the government's dime with universal free health coverage. After all, even if you and your sick children get free medical treatment, you still have to work to feed them.
Not to mention that if many small businesses didn't have to worry about providing and subsidizing health coverage to attract employees, they could probably hire more workers for higher wages.
I actually think these potential talking points to use when trying to sell conservatives or moderates on the idea of single-payer and fully gov't subsidized health care.
Posted by: Adrienne | January 21, 2010 2:22 PM
I hope it doesn't pass and I am for a health care bill. If the government is going to come up with a plan, it is a government plan. The Republicans can't say it isn't, no matter what they put in it. Medicare part "D" is crap for a person who has more than two medications, but cost billions of dollars, which the Republicans don't want revisited or sacked. This is what this health care bill will be like, usable for far fewer people than expected and the implementation will be more bureaucratic than those praising it would admit. It will never be revisited in decades.
I feel the better plan would be to expand Medicare. The bureaucracy is already in place, no additional bureaucracy. It would cost the consumer about a quarter or less than the cost of private insurance and private insurers can bid to underwrite for the SSA.
Posted by: Hathor | January 21, 2010 3:33 PM
If we were playing a real game of political chess, I would suggest that the Democrats draft an excellent bill, and let the Republicans ruin it by voting it down. It's gonna fail anyway, so Democrats should at least try to look like they care about meaningful reform, and let the Republicans take the blame for the failure. The problem with this strategy is that many Democrats really don't want meaningful reform that will benefit the public at the minor expense of insurance companies. The truth is that insurance companies can buy Democrats as easily as Republicans, and we're fooling ourselves into thinking that the Democrats actually care more about average people than Republicans do. The Democrats* aren't "compromising" because of pressure from the Republicans; they're doing it because it's what they truly want.
Posted by: catgirl | January 21, 2010 3:37 PM
Personally, I don't think the health care bill is dead. Further, I think there's some merit in the argument that getting a health care bill passed, even if it's better characterized as a "health care bill", is a valuable step forward.
But the alternative — starting from scratch — has something to recommend it too. First, it appears that starting over would mean multiple bills, each addressing a part of the problem. One bill, for example, might put the kibosh on insurance company practices of recission and rejecting applicants for "pre-existing conditions." Such a bill would be relatively short and, more important, much easier to explain to the public. (True, the Republicans can be counted on to try and block it. Let them; they'd only seal their electoral fates.) Second, it ought to speed up the legislative process because committee deliberations and floor debates can be more focused, and hence shorter.
Posted by: Chris Winter | January 21, 2010 3:45 PM
Raging Bee wrote: "(And no, bitching about the number of pages says absolutely nothing useful; it's just another shrieking-point for people who want the Bible to be their only law, and can't even understand that.)"
Beautifully phrased! I may steal part of that.
"He that hath ears to hear, let him hear."
Posted by: Chris Winter | January 21, 2010 3:50 PM
Hathor, catgirl, Chris... Do you have any idea how Congress works? What the rules are governing the process?
I also want Congress to pass a law creating eternal World Peace and ending pollution, while boosting economic growth and eliminating deficit in 3 years.
Now can we talk about something realistic?
Posted by: bullfighter | January 21, 2010 4:11 PM
bullfighter,
Do you have any arrow in your quiver beyond: I'm smart and I understand; you're dumb and you have poopy pants.
It's getting a bit old.
Posted by: heddle | January 21, 2010 4:15 PM
Also, ending pre-existing condition exclusions without mandating coverage is an incredibly stupid idea. That so many on the left are still supporting it just shows that the right has no monopoly on stupidity and religious fundamentalism.
Posted by: bullfighter | January 21, 2010 4:20 PM
Esheddlichia coli: "Do you have any arrow in your quiver beyond: I'm smart and I understand; you're dumb and you have poopy pants."
Sure I do, but I save it for opponents who have weapons other than their poopy pants.
Posted by: bullfighter | January 21, 2010 4:23 PM
Is it me or has Ed's blog had an abundance of silly bickering and poop jokes over the last few days?
If you're going to insult someone, at least be clever, witty, and entertaining. Come up with something better than "poo poo head" or its scatological sister insults, will ya?
Posted by: Adrienne | January 21, 2010 4:51 PM
Adrienne:
1. Some people discuss actual issues.
2. Some bozos complain that the bills are too complicated for people to understand, and if those darn legislators and that darn president could just write and speak more clearly, everything would be hunky dory.
3. Some of the first-mentioned people point out that the complaint is a truckload of manure.
4. Some of the second-mentioned people dig deeper, and some of the first-mentioned are having some unserious fun.
5. Adrienne complains about... what exactly? Did somebody say "substance"? Nooo...
Posted by: bullfighter | January 21, 2010 5:14 PM
Dan L.:
That is the red herring that will keep us running in circles until crisis forces the issue. The total, society-wide cost of health care, not “who pays for it,” is our fundamental problem.
A few random thoughts related to the above:
1. Any health care “reform” that doesn’t have the effect of realigning incentives so that more new doctors go into primary care — and perhaps also that more routine care can be delivered by nurses, pharmacists and other more client-centered and less over-trained professionals — misses the point so far as to be a hindrance rather than a help.
2. There is no economic sense to the attachment of health insurance to employment. Either employer contributions to health insurance should be taxed as income benefits, or individual payment of health insurance premiums should be allowed as a deduction — unless, of course, we’re trying to make it hard for employees to leave jobs which are ill-suited to them: a goal that has no economic justification.
3. Using insurance for routine health care is irrational (as if you bought insurance against the need for an oil change in your car – it would always be a losing proposition for you). At the same time, we want people to avail themselves of simple, immediate, high benefit-to-cost-ratio care when it can do the most good. My solution is that routine care (and yes, defining that would be a challenge) should be automatically paid for by the government, but billed over a five year period, with interest, as an addition to the patient’s income tax. (Low income individuals would qualify for a longer period and/or a write-off of part or all of the debt.) The taxpayer would be free to pay off the debt at any time, including at the time of service (interest making this the best option for those who can afford it). This would both help to avoid situations where people don’t get immediate care because they can’t pay for it at the time, and also assure that the cost of care factors into people’s decisions, making routine health care a more normal, functional market. It would also get insurance out of the routine care business, where it doesn’t belong and only adds to the total cost of health care. Providers could deliver care without prejudice, since they would know they would be paid by the government regardless of what the patient chooses, or is able, to do; yet prices would not need to be fixed by fiat (as with Medicare) since patients would know they ultimately will foot the bill.
Posted by: Coises | January 21, 2010 6:00 PM
As the Senate health bill will not stand up to a House vote, IMO, the wisest course of action is to shelve health reform for now, and instead focus hard on deficit reduction and passing a payroll tax cut - issues which Republicans would be stupid to oppose (not that they wouldn't do so anyhow; from here on out they are going to turn their obstructionism up to 11).
Then return to health reform in 18 months with the bill boiled down to its essential components (e.g. barring insurance companies from rejecting customers based on pre-existing conditions, etc.), and pass each separately.
The Dems have zero time to mope about losing Ted Kennedy's seat, and have to move ahead now.
It's up to Obama to take the reigns. If he learned anything during his first year in office it's that delegating decisions to Congress is a non-starter for any major legislation.
Posted by: CHV | January 21, 2010 6:13 PM
I'm confused...when the Senate passed the health care bill, did the Democrats have 60 votes? Wasn't Kennedy already gone by then? Didn't they get #60 from across the aisle? What am I missing?
Posted by: theberle | January 21, 2010 6:43 PM
Ted Kennedy has been suffering from his tumor since 2008. He's been wheeled into Congress on a stretcher for important votes. The guy was a fighter.
Posted by: Brandon | January 21, 2010 6:51 PM
Adrienne,
My bad. When someone pops in with nothing more than "I'm smart, you're an idiot" it pushes my buttons. I should just ignore such pinheads. I'll try harder. Apologies to other readers as well.
Posted by: heddle | January 21, 2010 6:53 PM
OK, bullfighter, I'm complaining about needless back-and-forth bickering that reads as though a bunch of sixth graders wrote it. Complete with unimaginative scatological humor. If you're going to continue insulting your interlocutors throughout the comment thread, at least make it interesting or funny, why don't you?
Or hey....just stop bickering. How's that for an easy solution?
Posted by: Adrienne | January 21, 2010 7:01 PM
Never mind...I forgot about Paul Kirk's appointment.
Posted by: theberle | January 21, 2010 7:01 PM
theberle, you are missing interim Senator Kirk.
Posted by: Chris From Europe | January 21, 2010 7:15 PM
Regarding the 2000 pages, the Canada Health Act of 1984 which governs health care in Canada is 16 pages. Since it is published in both English and Rrench, it takes up 8 pages in each language. It provides the framework, with details worked out between the federal Health Minister and their provincial counterparts.
http://laws.justice.gc.ca/PDF/Statute/C/C-6.pdf
Single payer is very simple, you see.
Posted by: JusticeLeague | January 21, 2010 7:47 PM
JusticeLeague,
What? You mean it doesn't contain provisions such as "$200 million for any province that lost a professional hockey team in the last seven years". And you call that health care legislation?
Posted by: heddle | January 21, 2010 8:03 PM
heddle-I am convinced that the difference is not that Canadians are morally better than Americans (though they are of course) but that in a parliamentary system individual members are required to support their party when the vote is called. Prima donnas like Lieberman would be crushed if they ever dared to stick their heads up.
I am convinced by this fiasco (and several others) that the US is doomed unless fundamental changes are made to the system so that parties that win elections get to actually omplement their platform and then get held accountable for its success or failure. The US model of the perpetual campaign can now be pronounced a failure.
Posted by: JusticeLeague | January 21, 2010 8:22 PM
Gingerbaker @28:
No, that would go far beyond the scope of a legitimate executive order because it's not just shaping how an agency operates, but dramatically expanding the scope and most especially the cost of a policy. It would also directly contravene the current law authorizing Medicare.
Heddle, Nearly all laws are exceptionally complex. One of the reasons is that most of the things the laws deal with are more complex than those of us casually gazing in from the outside can recognize. That's the necessary and legitimate complexity, which in itself makes writing a straightforward bill that will actually function well a rare thing. Extra complexity is added in by different members demanding specific items as the price of their vote. "We, the people" don't like that, but "We, the recipients of our particular legislator's earmakrs" generally do. And while it would be nice to think that "Congress" would act a particular way, it's not actually "Congress" that acts--it's the 535 individuals who make up what we collectively call Congress who actually act. So the only meaningful way to analyze the actions they take is from a standpoint of their own self-interest. Ironically, most of them would like Congress to stop acting that way, too--all of Congress, that is, except for themselves. What it comes down to in the end is that legislation is not really a process of people sitting around trying to do what's right, but a process of buying enough votes to get one's own preferred legislation passed.
Posted by: James Hanley | January 21, 2010 8:51 PM
P.S. The Canadian health care legislation is not really only 16 pages. As noted, it's just a framework and the details are settled afterward. In our case, many of those details are settled in the legislative process, rather than afterward. If you add it all up, the whole set of rules on the Canadian system isn't necessarily that much shorter.
Although not providing compensation for provinces that lost hockey teams is a good way to cut out a few extra, useless, pages.
Posted by: James Hanley | January 21, 2010 8:55 PM
Pity the Republicans in Congress won't listen to the Pentagon.
http://www.defense.gov/news/newsarticle.aspx?id=56820
Posted by: Shay | January 21, 2010 9:00 PM
A LINE IN THE SAND - From jacksmith - WorkingClass
http://fdlaction.firedoglake.com/2010/01/21/fixing-health-reform-through-the-reconciliation-sidecar-13-improvements-6-ways-to-save-money-4-important-benefits/
My Fellow Americans and People Of The World
A strong Government-run MEDICARE like Public Option is STILL! CRITICAL!
We have had a long hard struggle to find out what would be the BEST! that this congress and the Whitehouse could do to fix our highly dangerous, poor quality, most costly, and MOST! disgraceful healthcare delivery system in the world. It is clear that congress can do much more for the American people than what is proposed so far.
It is clear that congress can pass a strong GOVERNMENT-run public option CHOICE. Available to everyone on day one. Expand Medicare and not levy any new taxes on workers healthcare benefits and plans. LET THIS BE YOUR LINE IN THE SAND!
Lastly, there can be NO! INDIVIDUAL MANDATES without a strong Government-run MEDICARE like Public Option CHOICE. Or the American people WILL! and SHOULD! revolt with an all out CIVIL WAR against congress and this Government.
House and Senate progressives and the tri-caucuses should aggressively push for the inclusion of a strong Public Option, Medicare expansion, and no new taxes on workers healthcare benefits and plans. If the obstructionist kill meaningful healthcare reform, then you should kill this bill. Because it will be far worse than the healthcare disaster we have now. It's failure will be on the obstructionist heads. And they will be punished and replaced.
WITHOUT A PUBLIC OPTION CHOICE, THIS BILL WILL KILL FAR MORE AMERICANS THAN IT WILL SAVE.
What is proposed in the Senate bill is the worst case scenario for health-care reform. It would shift trillions of taxpayer, public and private dollars into the hands of the private insurance industry (The single most costly, deadly and dangerous product sold in America). And it would compel by law millions of Americans to financially support this oxymoronic criminal enterprise. You cant have a individual MANDATE WITHOUT A STRONG PUBLIC OPTION CHOICE!
You will have NO! realistic way of controlling cost and quality. Cost will continue soaring through the roof bleeding the American people dry, and KILLing our economy. And our quality of healthcare will continue to decline below our current ranking of "WORST! quality of healthcare delivery in the developed World".
From the very start, the American people have been crystal clear about what they wanted. They wanted a humane single payer system like the rest of the developed world has (HR676). Or at least a humane strong GOVERNMENT-run public option CHOICE!! This is what the American people gave the democrats control of the house, control of the senate, and control of the Whitehouse to do.
Those of you that can, should prepare now to remove every member of congress that fails to support YOUR healthcare reform with a strong Public Option, Medicare expansion, and no new taxes on workers healthcare benefits and plans. Run against them in teams if you have to. But take them out. And replace them with a strong single payer or PRO PUBLIC OPTION CHOICE candidate.
Now! is the time to bring maximum pressure on your members of congress. Contact your representatives and spread the word.
The Public Option http://tinyurl.com/yfftf76
H1N1 IS A WEAPON OF MASS DESTRUCTION!
I have to tell you now that the H1N1 virus is a man-made WEAPON OF MASS DESTRUCTION! and TERROR! It is a WEAPONIZED version of a flu virus. It has swept the planet infecting millions. And causing a global pandemic that has killed tens of thousands, and injured millions.
The H1N1 virus is the product of the DISGRACEFUL, GREED DRIVEN PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX! It was released in the U.S. in Texas in early January of last year, but not recognized until around April 2009 in California. The reason I know this is because when it came to America, it came to see me FIRST! How sweet...
This was around the time the MEDICAL INDUSTRIAL COMPLEX! assaulted the Whitehouse with all their devils deals to cripple and weaken YOUR! healthcare reform. Especially your right to have a single payer system like HR676 (Medicare For All) which most of you wanted.
They don't even want you to have your HUGE!!! compromise position of a strong government-run MEDICARE like Public Option CHOICE. To compete with their DISGRACEFUL, GREED DRIVEN, MURDEROUS, PRIVATE FOR PROFIT PRODUCT (The single most costly, deadly and dangerous product sold in America).
They also wanted to take away your rights to have your government meet it's responsibility to use it's full power to regulate, negotiate, and control drug cost, healthcare cost and quality. Something every other civilized country in the developed World has done for it's people. Their Greed! moral degeneracy and lack of patriotism knows no bounds.
Many of you will remember that before we knew about H1N1. I posted a open message to the President and Congress warning them to be vigilant about their health, and cautious about any medical advice they received. As I said then "they will not hesitate to try and hurt you".
The U.S. and the World have been under a BIOLOGICAL TERROR ATTACK! for over a year now. It is CRITICAL that We The People Of The United States take away control of our healthcare system from the GREED DRIVEN MEDICAL INDUSTRIAL COMPLEX!
For our own National security, and the security of the world.
A Strong, government-run, MEDICARE like Public Option CHOICE. Available to everyone on day one, with the full unfettered power of the federal government to regulate, negotiate, and control cost and quality. Would be the most workable way to deal with this global crisis at this time. Including patent suspensions as needed for national security or the greater good.
As an American I invite the peoples of the World to help us fix our healthcare crisis. And bring pressure on our government to meet it's responsibility to protect global security by controlling, and removing the corrupting influence of GREED and the PRIVATE FOR PROFIT motivations from healthcare in the U.S. and around the World.
I call on the governments of the World and the global intelligence community to track down these MASS MURDERERS, and bring them to justice. CONNECT THE DOTS! And be vigilant that they don't slip in another viral strain on you under the cloak of H1N1 sequestration.
Further, the proposed patent protection on biologic's must be stripped from the US bill. And greatly shorten/restricted, or abolished completely. This is a grave danger to humanity and global security.
I think President Obama is doing the best he can at playing the disastrous deck of cards he inherited from the previous administration. And I think he is doing an excellent job. But the wolves and devils of the medical industrial complex! are trying to exploit, and take advantage of his good heart, and desperate desire to help suffering Americans. But we must be strong and insist that healthcare reform be done right for the American people. Or everyone loose's.
This is all I can say in a message post. I'll try to find a way to tell you more later.
God Bless You My Fellow Human Beings
jacksmith - Working Class
p.s. The so-called nominal H1N1 virus is designed in such a way as to make it more lethal to children and young adults. The medical community must be more vigilant of secondary bacterial infections in the young caused by H1N1. And remember, a viral infection is also a transfer of genetic code to you. Think about it, and be vigilant. :-(
Posted by: jacksmith | January 21, 2010 9:06 PM
James Hanley- You are correct and that is truly a huge problem. The only way that large issues can be tackled is for members of Congress to put the country ahead of their district. And that can only be done through vigotously enforced party discipline. Think of party like a brand. If one buys Coke, one should get Coke, not whatever the local bottler feels like sticking in the bottle that day. And if one elects a Democrat or a Republican or any other party, one should get someone who will vote as advertised in the party platform. Otherwise, you just have a free-for-all of special interest favors, like you have in Washington.
Yes, I noted that the Canada Health Act is a framework. And that's how the health care legislation should be here. A framework with actual procedures dlegated to HHS and state Health Depts. That's the only way to make it work, whether you play hockey or baseball.
Posted by: JusticeLeague | January 21, 2010 9:09 PM
Gotta love the conspiracy-loon spam. Where's Orly Tate - maybe she can take his case?
Posted by: Badger3k | January 21, 2010 9:22 PM
Coises: Using insurance for routine health care is irrational (as if you bought insurance against the need for an oil change in your car – it would always be a losing proposition for you).
That's demonstrably false. If you tend to postpone oil changes because you myopically perceive the expense as too large (or simply run out of money because you earn very little), then such an insurance policy would save you money in the long run.
People are much more likely to forgo preventive health care than routine car maintenance for two reasons. One, an oil change costs $30-40 while a routine physical (office visit plus typical labs) can easily exceed $300. Two, a neglected car will break down pretty soon, but human body can keep self-repairing for many years, and when it fails to self-repair, many people get used to some loss of normal function (especially if similar function loss is common among their peers by age and socioeconomic status).
Posted by: bullfighter | January 21, 2010 9:34 PM
The concern I have with your proposal is that it does come with a cost--putting the real meaningful, functional, rules of a policy in the hands of those who aren't politically accountable. (Ahem, not that I'm saying our politicians are particularly accountable themselves.) To some extent, with certain policies, that's inevitable. God forbid Congress should try to wade through the science necessary for filling in the details of the Clean Water Act, for example. And obviously Congress can't fill in all the details on any policy. But I would suggest your proposal goes too far in the other direction, at least for my taste, and that a barebones outline with the vast majority of the functional meaning filled in by the administrative bureaucracies is not democratic enough.
We may, however, be quibbling over whether we should move two units one or the other on the continuum.
Posted by: James Hanley | January 21, 2010 10:05 PM
James Hanley- First, HHS is accountable. The folks there work for the Secretary who works for the President.
The bigger issue is that letting Congress write the details inevitably brings pork-barrelling. This happens in the defense budget all the time, where a plane will have subcontractors in 350 Congressional districts, so it can't be killed even if it serves no military purpose. Letting Congress write the details of health care produces the same result-the MRI goes to the hospital whose Congresscritter's vote was needed rather than where it's needed most.
One of the main reasons for the success of US scientific reasearch has been that Congress stuck to setting the overall level of funding and let expert panels decide which projects should get what share of the pot. Now even that is breaking down as Congress is "targetting" funds to favored areas.
Posted by: JusticeLeague | January 21, 2010 10:31 PM
CHV: the wisest course of action is to shelve health reform for now, and instead focus hard on deficit reduction and passing a payroll tax cut - issues which Republicans would be stupid to oppose
Shelf HCR = "Sorry, America, we wasted a year for nothing!"
Deficit reduction: wrong time for it, we are still deep in recession. Deficit is a long-term problem. We have to do something about the deficit in 2030, and so it pretty soon (say in 2013), but doing it in 2010 won't make anyone's life better in 2010. Also, Republicans would certainly oppose it, as deficit reduction necessarily involves tax increases, and they would be smart to oppose it.
Even more importantly, there can be no serious long-term deficit reduction without health care reform, as practically the entire long-run fiscal gap is due to health care.
Payroll tax cut: well, they can do that, but if that's near the top of the legislative agenda, then they are truly useless. It would be a small, temporary measure with little effect, and Republicans would not go along, and again would not be stupid at all for obstructing it. They would simply point out that Social Security is no longer running a surplus (which, BTW, is due to the recession, but they would let the Democrats say the R-word and then blame it on them). Also, as a stimulus measure, a payroll tax cut is less efficient than direct government spending.
Posted by: bullfighter | January 21, 2010 10:45 PM
bullfighter/Coises-The car analogy really doesn't fit. All cars need a similar level of routine care. Humans not so much. The elephant in the room is that a relatively small part of the population accounts for the large majority of costs. In some cases their lifestyle is partly to blame, but in many cases it is simple bad genetic luck. And if you have MS, or Type I diabetes or Chron's or any of a whole range of diseases that you did nothing to bring on yourself you are easily looking at many thousands of $s each year just in ordinary routine care.
And what about procedures like colonoscopies, for example? They're damned unpleasant and even many well-insured folks skip them. Now suppose you have to pay $2,000 out of pocket. How many people will do that? Not very many.
Posted by: JusticeLeague | January 21, 2010 10:45 PM
JusticeLeague: I agree re: preventive care, but your "16 pages" argument is rather silly. Besides all that JH said (with which I agree), Canadian health care is not federal, but provincial. Federal law only lays down the ground rules that provincial laws must satisfy.
The US system of government is a major source of problems, but the size of the Democratic majorities makes that a very unconvincing excuse in this case.
Posted by: bullfighter | January 21, 2010 11:07 PM
I tend to think of competently drafted legislation as analogous to software design only done by lawyers. Good legislation should be modular, i.e., reference as many other portions of law that are itself a consistent source to other legislation so a principle is drafted only once and therefore referenced many times rather than each bill containing redundant but inconsistent language to other bills. It should also consider the ramifications post-execution and insure its effects are both consistent with intentions and can be easily disseminated by those tasked with deciphering it, analyzing it, executing it, and repairing its defects.
Legislators should be tasked with developing policies, staffs and counsel should be focused on leveraging past bills or using the new bill as an opportunity to solve past defects. They should be focused on taking the policy and drafting legislation that will execute such policies, not read like a magazine article for those with short attention spans.
I would expect comprehensive reform of an industry to run in the thousands of pages. I read the House Bill and while it was a 10xx page document, we should also remember it was double-spaced and promiscuously foot-noted. That document only took me about four hours to read, I'd guess it was equivalent to about 225 pages if it had instead been single-spaced with end-notes not considered in the page count. I did not understand it all since it often referred to other passed legislation (which I think is a good thing, again, modularity which breeds efficiency and higher quality), but I hardly so any wasteful language contained within the bill.
Therefore people whining about the page count is much ado about nothing and possibly self-defeating. Bad legislation ends up in court with confusing recourses for judges or worse, bureaucrats who can't function and frustrated citizens who are a victim of such ineptness.
I think the Read the Bill movement is one of the most idiotic and ignorant movements I've ever encountered - a truly clueless movement with an ulterior motive - they believe conditions will improve if Congress is forced to reduce its legislative volume. I find that the equivalent of a manufacturer retreating in its ability to control its engineering specs - insane.
Growing a $14 trillion dollar economy requires competent governance that contributes to the competitiveness of the economy it serves. Given our competition continues to improve, there's little room for myopic overly-utopian cluelessness.
Posted by: Michael Heath | January 21, 2010 11:12 PM
But, why would they start panicking now? Brown voted for meaningful healthcare reform in Massachusetts. The guy even said, "I think it's important for everyone to get some form of health care."
Oh wait, I know, because they're spineless idiots. This wasn't a vote against health reform.
Posted by: Vene | January 22, 2010 1:39 AM
Vene,
Brown has already said that he would not vote for any meaningful reform at a national level.
Posted by: Jim S | January 22, 2010 2:39 AM
Mike the Mad Biologist points to this poll.
Comparing this poll to the 2008 election, the numbers are:
If Coakley had aggressively supported a public option, she would have done a lot better. (Separately, if she had had a better record as a prosecutor that would have helped too - and that is, or should be, very important to all liberals.) The natural conclusion is that she lost because voters thought she was almost as conservative as Brown, and they wanted a liberal.
The reaction of Pelosi, Frank, and many others seems to be the typical reaction of Democratic politicians who have just lost: Move right. But the federal Democratic politicians have been moving right for 30 years, and for 30 years, it has been, with a few exceptions, a losing strategy. On most issues, the Democratic base polls substantially to the left of the Democratic leadership, and is constantly saying they are disheartened and disappointed by how conservative the Democrats they elected have behaved. Many have even said they feel betrayed.
(And as I pointed out on a previous thread, if Gore had been a loud mouth about his stance on environmental issues in 2000, he might have won in Florida.)
There are some people here who rant and rage at "radical liberals" who don't want to support conservative Democrats. But the Democratic leadership consistently ignores the polls, the letters, the petitions, and the protests that show their base wants them to be more liberal. And if you want someone to be more liberal, and they clearly won't listen to polls, petitions, and protests, what else can you do?
Posted by: llewelly | January 22, 2010 6:26 AM
(*sigh* Trying again, because I have got to figure out how to get the section I quoted formatted so that it is readable.)
Mike the Mad Biologist points to this poll.
Comparing this poll to the 2008 election, the numbers are:
If Coakley had aggressively supported a public option, she would have done a lot better. (Separately, if she had had a better record as a prosecutor that would have helped too - and that is, or should be, very important to all liberals.) The natural conclusion is that she lost because voters thought she was almost as conservative as Brown, and they wanted a liberal.
The reaction of Pelosi, Frank, and many others seems to be the typical reaction of Democratic politicians who have just lost: Move right. But the federal Democratic politicians have been moving right for 30 years, and for 30 years, it has been, with a few exceptions, a losing strategy. On most issues, the Democratic base polls substantially to the left of the Democratic leadership, and is constantly saying they are disheartened and disappointed by how conservative the Democrats they elected have behaved. Many have even said they feel betrayed.
(And as I pointed out on a previous thread, if Gore had been a loud mouth about his stance on environmental issues in 2000, he might have won in Florida.)
There are some people here who rant and rage at "radical liberals" who don't want to support conservative Democrats. But the Democratic leadership consistently ignores the polls, the letters, the petitions, and the protests that show their base wants them to be more liberal. And if you want someone to be more liberal, and they clearly won't listen to polls, petitions, and protests, what else can you do?
Posted by: llewelly | January 22, 2010 6:29 AM
Michael Heath-The issue is not the length of the bill, but the reason it is so long. It is inordinately complex and it is that way because of the need to placate so many disparate interest groups and win support of "free agent" legislators who care neither for the nation nor their party, but only for their careers, their home state and their campaign financers. As a result the bill forfeits popular support because few can say for certain how it will affect their lives.
If the US had the type of party discipline you had in parliamentary systems we could have had a solution that everyone would understand and that built on current strengths, namely allowing the uninsured to buy into Medicare with sliding subsidies based on income, while allowing those with good private insurance to continue unaffected. That bill mught have been 10, 100 or 1,000 pages, but the jist of how it works would be clear to all and could be explained in a few sentences. Just try that with the Senate bill.
Posted by: JusticeLeague | January 22, 2010 6:30 AM
I'd hate to think that Health Reform is dead simply because Democrats lack a super majority in the Senate.
Posted by: MarkusR | January 22, 2010 8:08 AM
Ugh, are we really going over the car insurance metaphor again? This elucidates two major obstacles to health care reform: people focus to much on the "insurance" part and not enough on the "care" part; and people just don't listen. A body is not like a car; the analogy is really crappy one. If you can't afford to maintain your car and you can't afford to buy car insurance, there are plenty of things you can do, such as getting a cheaper car, getting a more reliable car, or having no care at all. However, you can't trade in your body for a younger model, and you if you decide that you simply can't afford to take care of the body you have, then you could just die. If your suggestion is that we treat health care like care insurance, you're suggesting that poor people should just die if they can't afford insurance.
On top of that, we already have a form of "insurance" for health emergencies that would be equivalent to a car wreck. Legally and morally, we can't refuse treatment to a patient in an emergency if they go to the ER. We've decided (rightly, IMO) that our society won't allow people to just die of a heart attack because they're poor. However, this costs us money in the long run. If people have good insurance that covers routine things like oil changes and annual physicals, then they're much less likely to have their car or their body break down in the future. Helping others helps us. Unless you would really prefer that we just let poor people die, the only other way to save money is to spend more money on preventative care. You should look at it as an investment.
But honestly, we've gone over this so many times already, and people still don't get it. Your body is not a car. Just because two things have the word "insurance" in them doesn't mean that they are completely analogous.
Posted by: catgirl | January 22, 2010 9:12 AM
I'm a Canadian and for 25 years I paid my taxes and didn't receive much from my health care. Oh, I got the usual doctor's visits etc, but it was never anything major. In August of 2005, I got cancer, and not a good kind, a very aggressive brain tumour, glioblastoma multiforme stage 4. I have not paid a thing for my treatment except the deductable on my drugs, which comes, with my salary, to about $500 per year which is still a deal given that my drugs were costing me in the neighbourhood of $4500 per month.
The care I've received has been the equal of anything in the States, including the top cancer centers at say Duke Medical School or M.D. Anderson in Houston. Everything that is available there is also available through Cancer Cancer Manitoba.
So what's the difference? I don't pay anything out of pocket. I haven't lost my home. I've been working continuously throughout the period, providing for my family and I hope to continue doing so into the future, despite the fact that I was supposed to be dead by Christmas 2006.
What frustrates me about the health care debate in the States is the amount of mis-information that is being passed around largely by the Republicans and the media. The media especially has done a very poor job of fact checking, preferring to have this pretend battle between two sides when there really isn't two sides. The Canadian system is not perfect, but if you want to have catastrophic coverage it is the best out there. It's certainly better than the alternative in the States.
The bottom line is that a lot of people are being lied to and they're not even smart enough to realize it. That's truly sad.
Posted by: David Ball | January 22, 2010 9:37 AM
JusticeLeague,
Who says the bill can't be explained concisely? Even a wonkish and detailed summary (by CBO: http://www.cbo.gov/ftpdocs/108xx/doc10868/12-19-Reid_Letter_Managers_Correction_Noted.pdf) fits in about 7 pages (the rest of the document is the analysis of its budgetary effects). And if this is too much, there are plenty of 1-2 page summaries around, many of which do a decent job (but may be biased, so I'm not going to link to any particular one).
Posted by: bullfighter | January 22, 2010 9:46 AM
bullfighter, Your link doesn't work.
Regardless, though, I suggest that if you quizzed a group of ordinary citizens on the specifics of the bill, most would do rather poorly. And like it or not, that makes it hard to marshall public support, which is what you need to overcome the powerful lobbies against it.
Contrast that with allowing anyone to buy into Medicare. All you need to know is:
1. All your relatives on Medicare are happy with it.
2. Here's a table with how much your premiums would be based on your income.
3. If you'd rather keep the private insurance you have, go ahead.
End of story. That could be sold much better than the current bills, if anyone had the balls to try.
Posted by: JusticeLeague | January 22, 2010 10:11 AM
Seven pages? One or two pages?
If it can't be summed up in one or two words, it's uncompact and, therefore, unpatriotic, unpartisan and unAmerican.
This is why nobody likes the Democratic Party. They're always using their words and stringing them together into sentences, paragraphs, chapters and the like, just to show conservatives how smart they think they. The Right, meanwhile, is so genuinely smartlike, streetsmart and something else that it only needs at most three words to destroy what those pointy-headed liberals wrote. "DEATH PANELS!" "SOCIALISM!" "IT'S CARTER'S FAULT!"
Posted by: Modusoperandi | January 22, 2010 10:25 AM
Doesn't Massachusetts already have a state version of the very policies being discussed in Congress? I don't see how this election changes the dynamics of the situation at all.
Posted by: Shawn Wilkinson | January 22, 2010 2:00 PM
JL: I suggest that if you quizzed a group of ordinary citizens on the specifics of the bill, most would do rather poorly.
But how is that different from any other bill? For example, most people have no idea what's in the USA PATRIOT Act - and it passed with no resistance.
Ordinary citizens NEVER know much about substantive issues.
Contrast that with allowing anyone to buy into Medicare.
Besides the pesky little detail that it would be a budgetary disaster if it wasn't coupled with a mandate, knowledge and understanding wouldn't be much improved. Haven't you heard all those "Keep government out of my Medicare" grunts and growls?
Posted by: bullfighter | January 22, 2010 2:07 PM
Shawn Wilkinson: Doesn't Massachusetts already have a state version of the very policies being discussed in Congress? I don't see how this election changes the dynamics of the situation at all.
Yeah, and John McCain ran on the platform of giving every American seven houses.
Posted by: bullfighter | January 22, 2010 2:09 PM
My point was not the development an analogy between human bodies and cars.
Apparently I was not clear, and/or I hit a hot button of some sort.
bullfighter:
That is true, but such an individual would not choose to purchase such a policy; and the individuals who would choose to purchase one would not be helped by it.You have uncovered one of my unstated (and unnoticed) assumptions: that no acceptable system forces people to do otherwise than they would freely choose “for their own good.” Of course, lots of folks don’t agree with me on that.
JusticeLeague:
Yes, the elephant is there, and yes, we ignore it at our peril. In regard to my assertion regarding insurance and routine care, note that I carefully avoided defining “routine care,” saying only that doing so would be a challenge. However, I can say at least that by “routine” I meant “routine throughout the population,” not “routine for a specific individual.” I see no plausible way to avoid using some form of cost spreading for “bad luck,” be it genetic or otherwise... in fact, that’s just what insurance is for in any other sphere.
My contention regarding insurance for routine care (though not my suggestion for government loans to replace it), as well as the observation that employer-paid insurance is an accident of the tax laws that makes no economic sense, are points I remembered from an essay on health care in the United States by Milton Friedman. (Unfortunately, I no longer have a link to that essay.) While I don’t often agree with him, I do think that one area of health care — what I termed “routine care” — could become a more-or-less normal, functional market, and that improved care at lower costs would probably result.
That wouldn’t address the elephant, but at least it would separate from it the common, relatively mundane services that comprise the bulk of most people’s interaction with the health care system, and let us deal with the beast on its own terms.
I think a real, functional market would at least align incentives better toward reducing both the costs and the unpleasantness of routine care... a better bet, in my view, than trying to stack the deck by hiding costs in taxes and/or insurance premiums to encourage people “to do what’s good for them.”catgirl:
I agree. Insurance is merely a means to an end... as is typical in political debate, it is mistaken for an end in itself.
However, we can’t escape the economics of health care... my “fundamental problem” and JusticeLeague’s elephant. As medicine has improved over the centuries, the result has been not less but more medical intervention. We have not solved the problems of sickness and death. Instead, we push back until they reappear in more difficult forms, and we battle them on more, and more challenging, fronts. In the foreseeable future, we can only expect this to continue.
Consider: “A just society should assure that every member is able to receive all desired health care that is medically indicated.” On the surface it seems like a reasonable proposition; but we can’t do it. Health care could expand to take up virtually the entire economy, and there would still always be more we could try, if the alternative were morbidity or death and we were allowed to put a price on neither. Eventually we would simply run out of resources — after already diverting the resources that now go to producing much of what we feel makes life worth living. We are all going to die. At one time, medicine was limited by what it knew how to do; now it is limited by the resources we can expend upon it without unacceptably diminishing the day-to-day quality of life for everyone.
It is an ugly and unpleasant truth, but it remains a truth. Some system must allocate scare resources. I doubt that any system which does that in the realm of health care will be generally perceived as fair. The unfairness, though, is inherent in the human condition, so we must find some way to make the best of it.
I’m not sure this is directed to me; if so, it is misdirected. I did not suggest that we treat health care like car insurance: only that there is a significant segment of health care that could be dealt with as something akin to a normal market (without widespread reliance on insurance; though of course individuals would be free to purchase insurance if they valued predictable costs over lower expected costs — a situation that would do a lot to force insurers in that market to be more competitive), and that this would be highly likely to improve health care in that segment. (I also specifically suggested automatic government loans, with extended repayment and/or write-off of the debt for low-income patients.)
We can also look to make the system more efficient and effective... this is part of focusing on the “care” and not just the insurance. However, since we live in a society where nearly every organized, professional activity is primarily driven by money — and we can’t hope to change that soon, whether we like it or not — most ways in which the system could be made better will only happen if financial incentives favor them.At present, I actually favor a single-payer system, but with the adjustment that the costs of “routine care” (however that would be defined) fall back on patients (with exceptions at the low end of the income scale, and automatic loans both to ensure that those who can pay are not trapped by cash flow limitations and to prevent a patient’s financial status from being any rightful concern of providers), thus letting fairly normal market forces work out the balance of costs and services for people’s most common encounters with the health care system.
Dealing with “the elephant” is harder, but the best solutions I can see are single-payer. Insurance (at least as we know it now) is something I’d like to see go away as a significant factor in health care. I can’t see how it does anything but take power from patients and doctors alike, while adding costs to pay profits that result from activity that is pure overhead and doesn’t contribute to quality care at all.
Posted by: Coises | January 22, 2010 3:44 PM
Posted by: llewelly | January 22, 2010 5:43 PM
I want to work online ..
There are some thin if the legitimate work as a line there. Most are sites and marketing study for the site owner rich, not you. The only thing is true legitimacy Ebay, selling things you already own
www.onlineuniversalwork.com
Posted by: kiramatalishah | January 23, 2010 4:24 AM
Coises:
such an individual would not choose to purchase such a policy; and the individuals who would choose to purchase one would not be helped by it.
Both of which are assumptions you made up with no empirical basis whatsoever.
I think a real, functional market would at least align incentives better toward reducing both the costs and the unpleasantness of routine care...
And this one just runs directly against every empirical observation available. Why in the world would you believe that the market would align incentives properly? That's not what markets do. And what is a "real, functional market" for heath care, anyway? One of the main goals of any health care reform is to fix the myriad market failures.
I did not suggest that we treat health care like car insurance: only that there is a significant segment of health care that could be dealt with as something akin to a normal market
If you mean just routine preventive care, than it is hardly a "significant segment" in terms of cost. So, while your proposed "solution" would probably work well to achieve the goals you set, it would do nothing to solve any actual problem with health care.
But if you mean any predictable care, then your proposal would put a terrible burden on people with chronic or hereditary conditions, and the market for such insurance would either not work or produce highly undesirable results.
Posted by: bullfighter | January 24, 2010 11:14 AM