"This is quite a system. What do you call it?"

The Senate seems set to kill off the public option in exchange for a package of compromises on other issues. This is going to cause understandable heartburn among progressives, but do we really think that a member of Congress should vote against the whole bill if it's this compromise or nothing?

How would such a Congressperson explain that decision to one of her constituents? Consider:

Jane: So, Congresswoman, what's going to happen with health care in this country?

Rep.: Well, Jane, I've got good news and bad news.

Jane: Uh oh. Better start with the bad news.

Rep.: The bad news is, the health care bill isn't going to pass because I've decided to vote against it. And I'm the critical swing vote.

Jane: Oh, no. Really?

Rep.: Yes. You see, I'm just not convinced that it's a good bill. For example, what do you do?

Jane: I'm a cashier at the local Wal-mart.

Rep.: And do you have a family?

Jane: Yes. I'm raising two kids by myself.

Rep.: Must be hard. Do you have health insurance?

Jane: No, I don't. See, my employer doesn't offer it, but I can't afford to buy it. An individual plan is incredibly expensive. I was looking forward to health care reform because I thought it would have changed that. Wasn't it supposed to give me access to a health insurance exchange where everyone paid the same price?

Rep.: Well, yes and no.

Jane: Yes and no?

Rep.: I don't know how much you make, but it's quite possible you wouldn't have been on the exchange.

Jane: Oh, that doesn't sound too good. Maybe this bill was bad after all. Why wouldn't I?

Rep.: You might have gotten health care for free.

Jane: For free?

Rep.: Sure. The bill had a big expansion of Medicaid benefits so that if you're a working person without much money, you might have had access to government health insurance. No charge.

Jane: I thought the bill didn't have a public option.

Rep.: Oh, it didn't. That's why I voted against it.

Jane: But you just said I might have gotten free government health insurance.

Rep.: Right. But if you made more money, you might have lost it! Once you weren't eligible for Medicaid, you'd have to buy private insurance.

Jane: Yikes. Or what?

Rep.: Or you pay a fine.

Jane: That seems unfair. The government requires me to buy something and doesn't even give me any help?

Rep.: Oh, no, you would have gotten big help paying for it. Major subsidy.

Jane: Oh. Well, still, even with a subsidy, we all know how much insurance plans cost.

Rep.: Actually, they would have cost a lot less. Remember, everyone would have been paying the same price, and insurance companies would have been required to spend 90% of the money on health care.

Jane: I see. So you voted against this because there was no public option?

Rep.: Absolutely. It's just unfair to make someone buy something they can't afford.

Jane: And the public plan would have been free?

Rep.: No. It would have been financed through premiums.

Jane: So I would have had to buy health insurance anyway.

Rep.: You bet. That's how we get universal coverage.

Jane: But the public plan would have cost less because it would have been financed by the government, right?

Rep.: No way! It's a level playing field. That's why I was so excited to vote for it.

Jane: What does that mean?

Rep.: Basically, the public plan would have had to compete on the same terms as every other health insurance company, and be financed entirely through premiums you paid.

Jane: So why is it better?

Rep.: Because making you give money to health insurance companies is bad.

Jane: Oh, right. Because they can deny me coverage based on pre-existing conditions and charge me more because I'm a woman. That does sound bad, truthfully.

Rep.: Actually, the bill I'm voting against would have outlawed that. People couldn't be denied coverage because of pre-existing conditions anymore.

Jane: This is a lot to take in.

Rep.: You ready for the good news?

Jane: I could use some.

Rep.: The good news is, now that health care didn't pass, you don't have to buy insurance!

Jane: I don't?

Rep.: Nope. You can keep living just like you have been---with no insurance at all.

Jane: That's the good news?

Rep.: Absolutely. Wouldn't it have been awful to be forced to buy health insurance? I mean, those awful insurance companies.

Jane: But I want health insurance. That's the point! Where am I going to get it now?

Rep.: From a health insurance company.

Jane: You said giving money to health insurance companies was bad.

Rep.: Oh, the worst.

Jane: Do I get any help paying for it?

Rep.: No.

Jane: Can they deny me coverage because of a pre-existing condition?

Rep.: Yes.

Jane: Can they charge me more because I'm a woman?

Rep.: Absolutely.

Jane: And lifetime caps?

Rep.: I'd read the fine print.

Jane: This is quite a system.

Rep.: I'll say.

Jane: What do you call it?

Rep.: From now on? Liberalism.

Tags: Health care, health care reform, Medicaid, Public Option, Senate (all tags)



Re: "This is quite a system."

Very Entertaining.

by Jonathan Singer 2009-12-10 12:31PM | 0 recs
A horse named Trigger

masterful.  muchos gracias.

And for all that, I'd forgo the trigger as well.  If you want to see every last Senator  100 % bought and paid for by the Health Insurance Industry, introduce a trigger mechanism.

Secondly, what the hell is a Republican going to say in their re-election bid? "I fought against the single largest reform bill in the past forty years and it passed anyway".  Not the stuff of history books.

by the mollusk 2009-12-10 12:31PM | 0 recs
Bill is crap

This bill is crap becuase it doesnt provide reasonable and cost effective access to those who need it and it does little to reduce costs and nothing to address the shortage of primary care physicians......

by BuckeyeBlogger 2009-12-10 12:34PM | 0 recs
Re: Bill is crap

A lot of "the shortage" is due to the fact that the medical system doesn't WANT a lot of doctors to drive down costs.  Talk to docs about it, they will explaine it to you...their insurance premiums are killing them, as well as larger and larger med school tuition debt.

I guess your system would only be the one-payer govt. run option.  A laudable goal, but that kind of change is going to have to be incremental.  Sorry, we are American's that way...not too much of a good thing all at once.  ;)

by Hammer1001 2009-12-10 12:54PM | 0 recs
no, america is not about incremental improvement

This country is about daring to lead. We didn't go to King George and request incremental improvement in our tax situation with the mother country, we struck out on our own and made a new country based on principles only envisioned by daring thinkers of the renaiisance.

And guess what. We made a great country.
Its built in, now.

And the half-measures and nuanced, incremental approach won't work. It hasn't worked now.

Something else: Nancy Pelosi is quietly trying to kill small business innovation. She's got a bill that she keeps pushing that - are you ready for this? Wants to have open ceilings on SBIR grants - and then let big Venture Capital firms own the company.

Her husband is an investor.. go figure.
Meanwhile, the SBIR gets 4.3 percent of the entire extramural research budget, but employes 38% of the scientists and engineers in the US.

The senate wanted to pare that bill back from the house, but Nancy pressured guys like Rep. Markey from Mass. to keep the house bill which guarantees a big windfall from the VC profit when SBIR grants are cap-removed.

And who? Who else. The lobbyist firms. Did this.
Nancy got bought.  

by Trey Rentz 2009-12-10 01:04PM | 0 recs
incrementalism in US history

Actually the American colonists did request "incremental improvements" from King George. The Stamp Act of 1765 was repealed in 1767, for instance. However that repeal was followed by the Townshend Acts. Those in turn were repealed when the colonists protest and then the British levied a tax on tea. But demands for representation in Parliament went unheeded and events overtook the situtation. Moreover, the colonists were deepely divided a third were Tory loyalists, a third were pro-independence and third were wholly indifferent. It's hard to characterize a "we".

But the most historically egregious part of your statement is to assign the Founding Fathers to the period known as the Renaissance which is a historical period in Europe begins the transition from the medieval period to the modern era beginning around 1400 and originally centered in northern Italy and in Flanders.

You mean the Enlightenment or alternatively the Age of Reason, a period of remarkable political freethinking and scientific inquiry.

And yes American history has largely been characterized by incrementalism. Revolution has been rare, perhaps three or four social revolutions - the Jacksonian, Reconstruction and the Rise of Nothern Industrialism, the New Deal (which led to an incremental expansion of liberalism) and the Conservative Counterattack led by Reagan. And these were social revolutions that in turn had economic consequences.

by Charles Lemos 2009-12-10 01:40PM | 0 recs
Re: incrementalism in US history

Jefferson was heavily influenced by the Ideas of Rousseau, and believed that the salt of the earth was the repository of all good in the world. And thats a quote.

It is egregious for you to declaim our founding fathers as if they were not influenced by such thinkers.

Charles, JFK wrote an interesting paper on whether or not Neville Chamberlain, if he had returned home without a compromise agreement - and instead indicated that hitler was building up to go to war -

Whether or not the British people would have actually gone to war.  I believe his thesis was that they would not, they were not ready for it.

But what was interesting about the thesis, if I remember correctly - was that if Chamberlain had been more open - and had, in fact - been able to convince the British people of Hitler's true intent - without candy-coating it and going after half-measures.

They would have drastically shortened the war, and been more prepared.

To say American history is a progression of incrementalism is egregious. This is a country founded on daring principles that the French Revolution brought forth - and those principles were based on Renaissance thinkers and the men and women who fought and died for our country didn't do so in incremental , half measure

And neither did your friend. You will never know what happened to him. Maybe he tried to escape.
Remember him?

That tape you saw? I remember it. In my mind, he didn't just sit there and wait for the inevitable.
And when you're shot trying to escape, history can be re-written. Or videotaped.

Perhaps I am wrong. But then again.

Perhaps you are wrong.

by Trey Rentz 2009-12-10 08:07PM | 0 recs
Re: incrementalism in US history

Rousseau is not a product of the Renaissance. Rousseau lived in the 1700s. The Renaissance is the period in the 14th and 15th century.

You have the Renaissance confused with the Enlightenment.

by Charles Lemos 2009-12-10 08:35PM | 0 recs
Re: incrementalism in US history

To follow on what Charles said, the French Revolution actually grew in some sense out of the ferment of the American Revolution, not vice versa. The French Revolution began in 1789, long after the signing of the Declaration of Independence.  It's helpful to keep the history straight.

by jeffdavis 2009-12-11 02:19PM | 0 recs
Pelosi is a crook

Pelosi has always been bought. The woman is a typical corrupt politician, nothing has changed

by BuckeyeBlogger 2009-12-10 02:16PM | 0 recs
Ya' Think?

Here's what she actually said today:

"Well, what I said -- it is a two‑part statement that quotes what the President has said. We believe, we in the House believe, that the public option is the best way to hold insurance companies honest -- to keep them honest and also to increase competition. If there is a better way, put it on the table. As soon as we see something in writing from the Senate, we will be able to make a judgment about that. But our standards are that we have affordability for the middle class, security for our seniors, closing the donut hole and sustaining the solvency of Medicare. Responsibility to our children, so not one dime is added to the deficit. And accountability of insurance companies. We will take a measure of that bill in those regards," Pelosi said.

Ryan Grim - Pelosi Backs Off Public Option Huffington Post 10 Dec 09

Those don't seem to be weasel words, to me.  I can understand your frustration but the current health care paradigm is clearly unsustainable.  We must do something.

by Shaun Appleby 2009-12-10 02:53PM | 0 recs
Re: Ya' Think?

Not sure if Pelosi is a crook, I liked her first 100 days - she drained the swamp.

And I am sure you will agree the GOP strategy is to get the followers to go after the leaders.
Thats why they're hyping six out of sixteen thousand rambling emails from some climate change center. Because they are only able to hype things.

Nancy , however, has to come to grips with the fact that she was elected by progressive - and very rapidly changing electorate

Think for a second the deep stab the Dems made during the last blogosphere election of 2008,
amazing inroads into 'safe' territory for the GOP

Thats because there is no such thing as safe territory. If she wants to remain in power, she needs to stop worrying about the money -and making all her chairman positions go on about getting money from the lobbies...

And actually listen to , oh, I don't know... the 72 percent of Americans who support real reform.

She's like anyone else. This is her moment of truth. IMHO

by Trey Rentz 2009-12-10 08:11PM | 0 recs
yes america is about incremental improvement

Umml, the entire history of the US is incremental. The constitution didn't pop up over night. It took several years for it to get passed.

And there were some rather erroneous compromises even then - slavery and the 3/4th count to be exact.

by vecky 2009-12-10 02:45PM | 0 recs
Re: yes america is about incremental improvement

I agree legislation sometimes takes time to write, but the character of our country is not a nuanced, subtle thing.

America is a beacon to the world simply because we do not scatter ourselves around and forget who we are and then stumble upon a combination of thoughts and ideas that define us.

There is a character to our country. And it is not about increments. It has its Nuance, to be sure, and thats a cool thing.

And no, really we're not talking about legislative process here.... we're talking about who we are and what we stand for.

Go watch 'sicko'.. there's a scene it in where there is someone who is just dropped off at the corner by the hospital because they dont have insurance.  Stories about women who , because they weren't covered at a particular hospital according to the fine print of their policy, had to take their children to another hospital... and because of it the child died....

And there is the guy who had to choose which finger of two, that had been severed - to have sewn back on because he could only afford one.

Seriously. Are you really standing for half-measures,  here???

by Trey Rentz 2009-12-10 08:15PM | 0 recs
Re: Bill is crap

The larger reason is that specialist are much higher paid than family practice and general practice physicians. Until something is done about the pay disparity, nothing will change

by BuckeyeBlogger 2009-12-10 02:18PM | 0 recs
Re: Bill is crap

I assume their higher paid because they are specialists... duh!

Face it, once doctors view their work as a means to profit rather than a service... that is what happens.

How many doctors are going to accept being placed on a fixed salary "for the common good"? Why should they...

by vecky 2009-12-10 02:47PM | 0 recs
Re: Bill is crap

But there is a huge disparity in pay. Fact is that general practioners, be it family medicine, internal medicine are just as valuable. Its becoming unsustainable to the profession and the industry when those considered primary care physicians cant even eanr enough to support a family. We have a close friend who left the practice of family medicine becuase she could earn more as a researcher.....crazy

by BuckeyeBlogger 2009-12-10 03:44PM | 0 recs
Re: Bill is crap

Yep.  I'm in med school now, and pretty much the only way I'd be able to become a primary care/family medicine doc is if this disparity in pay is addressed.  I'm going to graduate with over a quarter million in debt, and will also have to put in at least a few years at a residency that pays an hourly wage that a Subway sandwich artist would recognize.  So it's looking like I'll be another superfluous anesthesiologist, because I'd like to be out of debt before I become eligible for this Medicare expansion.  Many of my classmates are of the same mind.

by gravypatrol 2009-12-10 04:32PM | 0 recs
Re: Bill is crap

Really a shame. You should be able to practice in primary care if you desire. My thought has been that one way of addressing this issue would be to have the Federal Government offer something like a 50 percent grant to med school students who agree to practice primary care, be it family medicine or internal medicine  for at least5 or 7 years after graduation.

by BuckeyeBlogger 2009-12-10 04:56PM | 0 recs
Re: Bill is crap

How does that math work out...

As a PCP you make about 180K a year. An anesthesiologist makes about 250k a year plus. So the difference is 70k a year minimum. 5 x 70 is 350K of lost income. In return he's getting 125K grant. He'll still be better off taking his $250K debt and forgoing PCP...

by vecky 2009-12-10 05:22PM | 0 recs
Re: Bill is crap

The disparity is even greater than that in my state (140k vs 300k or even more if I were to go into the pain mgmt route).  Of course, much of that is eaten up by the malpractice insurance rate, but we'll leave tort reform for a more appreciative blog...

That said, 50% off my loans would make the PCP route a lot more doable.  Interest savings alone would be phenomenal.  

by gravypatrol 2009-12-10 05:44PM | 0 recs
Re: Bill is crap

I've been in favor of tort reform, as long as it includes patient protections. However I don't see it as a significant silver bullet, 30 states have implemented tort reform and the PCP shortage is just as acute. But we can have that discussion...

Also, I don't think it's a winning argument to say docs need to be paid more (140K is three times avg household income) when everyone already says the current system is too expensive.

by vecky 2009-12-10 06:14PM | 0 recs
Re: Bill is crap

It may not be a winning argument, but it's true, especially when you factor in the ridiculous amount of student loans most have, plus the 3-8 years post med school residency that involves getting paid less than the average household income while working 80 hour weeks.  Plus, there's the aforementioned malpractice insurance.  If the costs for entering the medical world were significantly lowered, then salaries wouldn't be as much a part of the discussion.

But it really isn't about the money, I guess.  Most people will be drawn to medicine for the right reasons, it just kinda sucks that PCPs get the (relative) shaft at the moment.  The PCP shortage is likely to get worse, by the way.  Lots of older docs are nearing retirement.

by gravypatrol 2009-12-10 06:54PM | 0 recs
Re: Bill is crap

How much is malpractice insurance, for a PCP... ?

I heard it was in the range of 15K annually. Which while high is sort of dwarfed by other expenses docs have - paperwork and chasing after insurance companies for payments.

by vecky 2009-12-10 09:05PM | 0 recs
Re: Bill is crap

http://www.justice.org/cps/rde/xchg/just ice/hs.xsl/default.htm

Tort reform reduces costs neither for patients nor physicians.

by lojasmo 2009-12-11 03:28AM | 0 recs
Re: Bill is crap

While that's a link to the Trial Lawyers Association, this part was interesting:

"An analysis of data from the National Association of Insurance Commissioners (NAIC) and company annual statements shows malpractice insurer profits are 24 percent higher in states with caps.  In these cap states, insurers took in 3.5 times more in premiums than they paid out in 2008.  In contrast, insurers in states without caps took in just over twice what they paid in claims."

If true...  3.5 times more in premiums than payouts makes the 70% medical loss ratio look quaint. If true...

Maybe we need a PO for medical malpractice insurance...

by vecky 2009-12-11 09:18AM | 0 recs
Re: Bill is crap

I just threw out a number as s starting point. Maybe the deal is full ride in med school in exchange for the 5 or 7 years. I think the facts are that there are as many staying away from med school because they just cant afford it. Provide incentive for students to go to med school and become primary care physicians. In fact I dont know why more do follow the military route thru med school. A good friend of mine did and didnt pay a dime....

by BuckeyeBlogger 2009-12-10 06:48PM | 0 recs
Re: Bill is crap

Bit like the army huh?

You do know your talking full socialized medicine... govt pays for the docs, and then has full control over their career for set time period (5-7 yrs). Is this funded through general taxes btw?

by vecky 2009-12-10 09:00PM | 0 recs
Re: Bill is crap

No thats not what I am saying. I am saying that like the military commitment, the government offers to finance med school for those who agree to serve as primary care physicians for say 5 years much like one agrees to committ to military service in exchange for the education. After 5 years they are free to do as they see fit.

by BuckeyeBlogger 2009-12-10 09:12PM | 0 recs
Re: Bill is crap

That's pretty much exactly what they have now... sign up for military service, the military pays, you get trained and become a doctor, serve in the VA for 4 number of years at lowish pay and then your scott free... Your saying do the same thing, but without the military component. I don't think that is politically feasible, or even wanted.

And if your wondering why it's not more popular - it's the math. Cost benefit analysis, you make more money by taking a large loan and going into a specialty than the military route. Some people do it (I know one), but it's not preferred.

by vecky 2009-12-10 09:20PM | 0 recs
Re: Bill is crap

I would also like to add this is something private industry can do as well. Medical schools can give grants to students who spend 5-6 years in general practice, hospitals can cut the number of residencies offered in specialties in effect forcing  aspiring doctors to start off in general internal. That was in fact how it used to be. Everyone wants to be a specialist, but specialist residencies were rare and not given often so a lot of docs didn't have a choice so to speak.

by vecky 2009-12-10 09:45PM | 0 recs
Re: Bill is crap

Good points. SO the question is how do we get hospitals to see that increasing the number of residencies for primary care physicians at the expense of those for specialist residencies is in the interest of the entire health industry and the general public?

by BuckeyeBlogger 2009-12-11 08:23AM | 0 recs
Re: Bill is crap

Why is it in the interest of the health industry? They are making money...

For the general public, ya obviously it helps. But maybe the general public likes to wait in line to see a PCP but wants to get to see a specialist on demand.

You can be sure if more docs start becoming PCPs you'll start hearing stories on the shortage of specialists...

by vecky 2009-12-11 11:20AM | 0 recs
Re: Bill is crap

Government setting pay levels is not popular, see what's happening with the banking sector. This is an issue for the market to work out. Afterall less primary care doctors = short supply = higher prices = more primary care doctors. Right? Right?

That said there are provisions in the bill to encourage more docs into primary practice and more aid to medical schools.

by vecky 2009-12-10 05:06PM | 0 recs
Re: Bill is crap

The provision in this bill simply allows for more residency slots to be added in hopes of creatibng for primary caregivers. But its flawed because it does nothing to address the pay disparity. I am in no way suggesting the government can address the pay disparity, but by giving incentives in the form of grants and scholarship to med students who choose primary care and remain practicing for a certain number of years it would attract many more potential primary care physicians

by BuckeyeBlogger 2009-12-10 06:52PM | 0 recs

I am in no way suggesting the government can address the pay disparity,


but by giving incentives in the form of grants and scholarship to med students who choose primary care and remain practicing for a certain number of years it would attract many more potential primary care physicians

Isn't this the government addressing the pay disparity?

by ND22 2009-12-11 02:35AM | 0 recs
Insanity, Defined

Insanity is when you do something wrong, and it doesn't fix anything - and you still keep doing it that way.

Today, Nancy voiced the utterance that she will gladly kill off the bill. Healthcare reform that doesn't benefit the public, isn't healthcare reform. To have no element of the bill that directly addresses the simple fact that there isn't a way to get decent healthcare - a single element of the bill that was the centerpiece of a moving speech by Obama - the key element of the bill that won so much support from everyone.

Then there isn't a bill. Period.

The blogosphere has spoken: its an off-year election and those that are involved, and dedicated can flex their muscles in a way never before.

And yes, its about money. Our money. Not theirs.
Ours is more. And a good shade of green.

I am going to talk to Dean.

by Trey Rentz 2009-12-10 12:52PM | 0 recs
Re: Insanity, Defined

oh by the way, thanks to pelosi's backsliding and every democrat that keeps dragging their heels on real healthcare reform -

guess what.

the GOP has now erased their popularity gap and the incumbent democrats are now threatened in an off-year election.

so. we go from bush republicans, to progressive elections - and back to just plain old boring democrats that cant get anything done.

in six months.
drop healthcare reform and you might as well drop the re-building of the democratic party.

by Trey Rentz 2009-12-10 12:55PM | 0 recs
We are not going to have healthcare reform

The party simply cannot come together on the issue.  

by Kent 2009-12-10 01:01PM | 0 recs
Re: We are not going to have healthcare reform

Dean asked a simple question.

What I want to know is. Why are democrats supporting George Bush's war.

76% of all americans supported public healthcare reform. A bill with public elements passed the house, with the democrats in full unification.

A bill with public element unified the democrats, to keep the republicans from filibustering it.

And now, the big money is on the table and bribes are happening left and right. Look at what pelosi did to the SBIR funding re-authorization.

The entire SBIR funding program dies on Jan. 31st
and the Dept. of Defense was so pissed off at it all they passed their own version of a bill that reauthorizes it for themselves. And we're back to riders.

Anonymous riders are there because lobbyists are there. And when you claim there is no unity , even though all the votes are there...

Then I will give you this: there is also no chance the democrats are going to get re-elected.

America can change fast. Dean proved that.
They want real action and the blogosphere lets
them move right to where they need to be.

And all the lobbyist money in the world isn't going to fix that for you if your seat is up for grabs.

Skeletons leap out of the closet. Unity? no way. this is not a unity issue. This is a leadership corruption issue.

And guess what. Corrupt leaders really do get thrown out of power.

Go ask Bush.

by Trey Rentz 2009-12-10 01:08PM | 0 recs
Re: We are not going to have healthcare reform

Dean is also an advocate of the current Senate bill.

by the mollusk 2009-12-10 01:17PM | 0 recs
Re: We are not going to have healthcare reform

" And guess what. Corrupt leaders really do get thrown out of power.

Go ask Bush. "

I must have missed the point where Bush got thrown out of power. He finished his two terms without incident AFAIK.

by vecky 2009-12-10 05:32PM | 0 recs
Re: We are not going to have healthcare reform

Yes. You happened to Miss the Election of Barack Obama. And  you were also sleeping through the 2004 election in which a sitting president was almost thrown out of office, during wartime were it not for 50,000 votes in ohio.

And the rise of a popular movement that turned him into a lame duck president - of which some of us actually played a part.

I said thrown out of power, not thrown out of office.

by Trey Rentz 2009-12-10 08:18PM | 0 recs
Re: "This is quite a system."

Right, that's just it.  For all the talk that "teh mandate" is going to be the most unpopular thing ever, the fact is that the imaginary right to go without health insurance is just not that important to people.

If the bill doesn't end up delivering affordable health insurance to enough people, that's going to be the problem, not the mandate.

by Steve M 2009-12-10 01:25PM | 0 recs
Re: "This is quite a system."

Sane words.  And that's exactly how the electorate will score the outcome.

by Shaun Appleby 2009-12-10 02:41PM | 0 recs
Re: "This is quite a system."

90% of people want health insurance, so the mandate is neither here nor there.

10% however... they will make noise.

That said i've lived in a couple of European countries where you purchase your insurance from a private company. They have mandates too. Wasn't a problem there...

by vecky 2009-12-10 05:35PM | 0 recs
Re: "This is quite a system."

You don't think people will be outraged at being forced to buy health insurance?  If so, I don't think you understand the American people very well.  Furthermore, when they are forced to pay and get the same crappy care (denial of benefits, fighting their insurer for everything, etc.) they will become more outraged.  

For your European example to be on point, we would have to know of which countries you are speaking and what regulations are in effect to keep those systems in balance.  Simple statements like yours don't tell us anything.

by orestes 2009-12-11 05:49AM | 0 recs
Re: "This is quite a system."

The Netherlands. It never even occurred to me that I was paying a private company for health insurance, but I was and it was mandated.

As for the folk being outraged: the majority no, but a good number of people are outraged already and looking for reasons (rational or not) to be outraged even more. The argument that "I'm being forced to give money to a private insurance company AAARGH!" works on a gut level and we need a powerful counter argument...

by vecky 2009-12-11 08:48AM | 0 recs
which would be great

if this bill did something to limit future growth of health insurance premiums. Right now it doesn't even revoke the insurance industry's anti-trust exemption

The original idea behind the public option was to give people an alternative to private insurers who jack up premiums at two or three times the rate of inflation every year while denying coverage for needed medical care.

If people get subsidies for junk insurance that turns out not to cover most of the care they need, and becomes more expensive every year, they're not going to feel grateful to Democrats.

by desmoinesdem 2009-12-11 02:45AM | 0 recs
Re: which would be great

But I think you're supporting my point.  It's not the mandate that will be a problem, it's the absence of affordable health care.

by Steve M 2009-12-11 07:28AM | 0 recs
Re: which would be great

True... but the bans on recession and pre-existing conditions means that your no longer wed to your insurance company. If they jack up premiums you can (in theory) go to another company which may not have.

And there are other regulations that attempt to control costs - the 85% "medical-loss ratio" limit, as well as regulations on benefits.

I agree the PO a much better safeguard though.

by vecky 2009-12-11 08:55AM | 0 recs
You've made a serious point

in one of the most effective ways possible.  Many critics of the bill seem to have literally no idea of the many important elements at play.

The assumption is that the mandate is terrible because it will force people to buy insurance as it looks right now.  That would indeed be terrible. But with the exchange, the subsidies and the regulations it will be quite different.

And I've always thought the Medicaid expansion was critical and could not figure out why progressives never wanted to talk about it.

by femlaw 2009-12-11 09:33PM | 0 recs
Re: You've made a serious point

Posted in the wrong thread - my point applies to the discussion generally.

by femlaw 2009-12-11 09:34PM | 0 recs
Excellent dirary

One of the best ever.

There is a lot of good in HCR even without the PO. Sort of like the EFCA without Card Check.

by vecky 2009-12-10 02:41PM | 0 recs
Talking to real people versus making stuff up

I think when the American public realizes what this bill is, especially those from the ages of 27 to 54, who already feel screwed by this society- the shit will hit the fan. I have to question how many of you talk to people outside of your own economic bracket. Certainly the polling reflects what I am saying much more than what is posted online.

by bruh3 2009-12-10 03:27PM | 0 recs
Re: Talking to real people versus making stuff up

I talk to people outside of my economic strata all the time.  You see, I am a nurse at a major medical institution in the heart of the heartland.  If it wasn't for my clinic, I'd be living in a cornfield.

A vast majority of my clients are fixed-income seniors.  We also treat a disapportionate number of low-volume cases, and do a lot of charity work.

Also:  27-54?  WTF mate?  How does that demographic "already feel screwed"?

by lojasmo 2009-12-10 03:55PM | 0 recs
Re: Talking to real people versus making stuff up

Some folk are just bitter and like to cling to their guns and... oh, nevermind.

by vecky 2009-12-10 06:24PM | 0 recs
Re: Talking to real people versus making stuff up

Yes, and what is your sense of how people would react to the mandate?  Clearly, your dominant clientele will not be affected.  What are you hearing from others who will not be eligible for the poverty assistance?

I don't know how widespread or typical it is, but I do hear a fair amount of whingeing from the Gen X/Y types about having to support the baby boomers and fearing there will be no social security for them.  Again, I don't know if these complaints are significant and do not endorse these views.  

by orestes 2009-12-11 05:54AM | 0 recs
Re: Talking to real people versus making stuff up

It is significant. The sense is that the baby boomers are fucking us over, and this sort of policy making does not help with that assessment. Whether it is the out of control cost of education or a neoliberal job market that crashes just as we get at the point of savings in our careers (many of us are now out of work just as we were ready to move up enough to earn enough money to matter), we seem to be getting the short end of the societal stick while being expected to bare the burden of its cost.

http://www.huffingtonpost.com/2009/11/16 /recession-intensifies-gen_0_n_358642.ht ml

"Gen Xers get hit with a double whammy
First it was the bursting of the dot-com bubble ... and now this"


We are the first generation to face an America in decline. The reality is that previous to the early 90s these neoliberal policies were not in full effect. Now, that same generational group is being asked to bite the bullet on health care reform.  We have already done so on hyer inflationary education costs and other issues. There are a lot more issues related to this.

by bruh3 2009-12-11 06:29AM | 0 recs
Re: Talking to real people versus making stuff up

The gen Xers are not the first generation to face a country in decline.  The tail end of the baby boomers did as well.  Granted, education wasn't nearly as expensive, but job prospects were grim.

by orestes 2009-12-11 08:48AM | 0 recs
Liberal Appropriation Alert!

Great diary, but you could at least have credited Kozinski's dissent in Ramirez-Lopez. You took his whole concept hook, line and sinker and passed it off as your own.

by cjw79 2009-12-10 06:55PM | 0 recs
Re: Liberal Appropriation Alert!

Nice to see someone else has studied the classics.

by Steve M 2009-12-11 09:40AM | 0 recs
Re: "This is quite a system....

You're lucky they don't still burn heretics. Go over to FireDogLake and post this.

by Davis X Machina 2009-12-10 07:05PM | 0 recs
Re: "This is quite a system. What

All I know is that I am not sending a fucking penny to the DNC, DCCC, or DSCC if they are going to give money to the 4 "Democratic" senators or house members who aligned themselves with the Republicans on the public option.

They should be stripped of their chairmanships because they are going to singlehandedly cause close  seats to go into Republican hands in 2010.

Say what you will about Republicans, but at least they manage to unite together, unlike Democrats who are about as strong as a wet noodle.  I am extremely angry that the public option was cut out by 4 self interested senators.

by agpc 2009-12-10 07:24PM | 0 recs
Re: "This is quite a system. What

Its not out yet - this deal is not finished.

by Trey Rentz 2009-12-10 08:18PM | 0 recs
Re: "This is quite a system. What

You are correct.  I cannot judge the actual legislation until it is passed.  

I can, however, throw a fit if this select group of Senators (D) manages to defeat the public option.  This was the best opportunity we will have over the next 15-20 years to truly reform healthcare, and you have Lieberman sitting pretty on his chairmanship even though he helped defeat the public option.  Strip these folks of their chairmanships or I will have no money to give the DNC, DCCC, or DSCC in 2010.

by agpc 2009-12-10 11:47PM | 0 recs
Re: "This is quite a system. What

The Public Option however has been overblown. When it was tied to Medicare + 5 and open to all it made some sense. Now it will be a separate program with only 3-4 million customers and only in some states. Considering United Health has over 40 million customers, how is the PO going to take them on?

PO is only a hedge for those who don't like private insurance companies.

If the price for ditching the PO is allowing medicare buy-in at 55, that's a good deal IMO.

by vecky 2009-12-10 11:55PM | 0 recs
Lieberman is blocking medicare +55

Its looks like that is now out.  

by Kent 2009-12-11 01:17AM | 0 recs
Re: "This is quite a system. What

The Medicare buy-in only matters if it is affordable.  At present, it appears it will not be.

by orestes 2009-12-11 05:56AM | 0 recs
Re: "This is quite a system. What

I think it will be more affordable that the exchange rates. Because it's tied to medicare and medicare is a large pool which can pay lower re-reimbursement than the PO could, not only will the premiums be cheaper, the subsidies to make those premiums cheaper will also be cheaper.

by vecky 2009-12-11 09:03AM | 0 recs
Re: "This is quite a system. What

"More affordable than" is meaningless.  At present, it appears the Medicaire add-in will not be affordable to most Americans.  Furthermore, if it is tied to Medicaire and is affordable, this poses a problem because it shifts a lot of high risk insureds onto the public.  I am sure the insurance companies would love for the plan to be attractive to 55+'s because it will move them right off their books.  An added bonus for the insurance companies- not only do we get millions of captured customers, we also get to get rid of them when they really start to need services.    

by orestes 2009-12-11 10:18AM | 0 recs
Re: "This is quite a system. What

First off, these "high risk" folk will end up on the public anyway. In the 10 years between 55 and 65 it's not like they are getting any healthier. And of all the decadle age groups, 55+ has the largest percentage of folk on medicaid.

Secondly, Medicare already has a buy-in for folk over 65 (who do not have the 40 quarters of contributions). It's currently around 550$ a month (450 part A, 100 part B). For those still working, you also have to add the continued 1.45% payroll deduction. Which, compared to private insurance rates for the same age group is cheap.

Thirdly, folk who have insurance through their employer won't be eligible for the buy-in - unless the employer only has workers 55 and over. There are already laws that prevent employers age discriminating. Anyway, if employed folk come onto medicare it won't be a problem because if they are earning and employed they are probably reasonably healthy.

So what if insurance companies benefit? The elderly get health insurance, and the below 55s should get cheaper rates.

by vecky 2009-12-11 07:21PM | 0 recs
Re: "This is quite a system. What

The issue is not whether more people will get health insurance.  The issue is whether this is a wise approach to solving the health care problem.  I do have a problem with the insurance industry benefitting from these reforms while most of the burden is placed on the public dole.  I think responsibility should be shifted to the insurance companies.  Let them assume the costs as a simple cost of doing business.  If they don't want to accept the burden, they can dissolve and a public plan can take its place.

by orestes 2009-12-13 02:18PM | 0 recs
Re: "This is quite a system. What

The Medicare buy-in only matters if it is affordable.  At present, it appears it will not be.

by orestes 2009-12-11 05:57AM | 0 recs
Re: "This is quite a system. What

Hasn't been scored yet.  Where are you getting your information?

by lojasmo 2009-12-11 06:19AM | 0 recs
Re: "This is quite a system. What

Oops.  Reported score saves $25B.

by lojasmo 2009-12-11 06:24AM | 0 recs
Re: "This is quite a system. What

I mean affordable to the consumer.  

On what basis does it save $25 billion?

by orestes 2009-12-11 10:20AM | 0 recs


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