Health Insurance Reform

Its worth noting that the WH is refering to the reform as "HIR" and not HCR. As framed, there are some very good things in this bill-- C & R notes ten of them.

In terms of Healthcare reform, the jury is still out. The mandate for tens of millions to buy insurance from private corporations is years away, along with whatever enforcement that entails. However, it should be noted that Bernie Sanders was able to include a significant foot in the door in regards to having a public healthcare option available:

Authorizes early funding of community health centers in all 50 states (Bernie Sanders’ amendment). Community health centers provide primary, dental and vision services to people in the community, based on a sliding scale for payment according to ability to pay.

The mandates for private insurance are a terrible idea (especially politically), exchanges are better, but for real HCR, we'll need a national single-payer system that replaces exchanges, mandates, and subsidies. I'm pretty sure too, that it would be wildly popular. Congrats to the Dems in the House for making the first step.

[UPDATE] Good question in the comments of when something like single-payer may actually happen. I would think, that the next window of opportunity is not for another cycle or two. Also, what Jane Hamsher points out about the Mandate Mania, is really the next battle. But unlike Gay Marriage, which is very polarizing, the mandate for indivuduals to buy private insurance is popular with very few besides the liberal political wonks, and toxic among Libertarian Democrats.

FDL counts 31 states where anti-mandate organizing is already happening. Here in Virginia, politicians have already made the mandate a Mandate-In-name-Only, by allowing its citizens to avoid any federal mandate to buy health insurance. The measure passed the Democratic Senate 23-17, and then passed in the Republican controlled House of Delegates by a 80-17 landslide.

So, to answer the question. I except that as the mandate becomes something that a minority of politicians embrace, it's either going to break toward a public plan emerging, or a repeal of the mandate.

The latter could happen from either the Republicans gaining control of Congress and repealing the mandate (tough to imagine that Obama, whom sucessfully used it as a political wedge against Clinton & Edwards in the 2008 primary, would veto this too); or, the Republican 5 on SCOTUS find the mandate unconstitutional.

What's interesting too, is how Democrats in DC view the liability of the mandate as the lesser of evils. What was more important was to get a CBO score that reduced the deficit, hence the mandate to get that number.

How does the break happen toward a public plan? Well, the first step is going to be to have a vote on it. Activists are going to have to really shake up Congress to get there, and knowing where each Democrat stands is only first base, and we haven't even gotten there yet.

So, lets just leave this as recognizing that Democrats accomplished substantial Health Insurance Reform. It took way too long, but its finally, whatever you want to call it, been achieved.

[UPDATE] Not unexpectedly, Republicans are throwing things in the kitchen:

"There will be no cooperation for the rest of the year," McCain said during an interview Monday on an Arizona radio affiliate. "They have poisoned the well in what they've done and how they've done it."

Wil this kill the Energy/Climate, Kerry-Lieberman-Graham legislation is what I'm wondering, as that was the biggest hope of this whole cycle imo.

Tags: hcr, hcr (all tags)



How long this time.

Has anybody mapped out a stratigy for Single payer? Will it happen on Obama's watch? Will Medicare for all be our wedge?

by eddieb 2010-03-22 10:04AM | 0 recs
RE: How long this time.

Medicare-for-all-plus-VAT is the only plausible route to single payer. It will take some time though. In the meantime I think a medicare buy-in for the over 55 crowd is a good middle step.

by vecky 2010-03-22 11:48AM | 0 recs
RE: How long this time.

Medicare buy in for everyone solves the problem. Alan Grayson FTW

by Trey Rentz 2010-03-22 01:43PM | 1 recs
RE: How long this time.

Agreed.  Single Payer is a pipe dream.  THe only way it would ever have a shot in hell of happening is if lobbying laws are changed and the constitution is changed to prevent companies from donating, influencing elections.   Single payer will drive down Doctor's fees so the AMA will be against it, it would destroy the insurance companies, so they'll be against it... it would put a TON of people out of work, which will cost you politicians in states hit hard, it would have to control drug costs, so Pharma will be against it.   I don't see a way in hell it happens, especially given that it would put millions out of work.

Plus you'll have 20-30% of the country against it right off the bat.

Medicare Buy-in is the way to go.  It's a public option, its already in place (so costs are cheaper for start up), and it actually has a chance of passing.

by FUJA 2010-03-22 06:17PM | 1 recs
What's the premium?

Give me a number for a family of four. And don't forget the cost of adding pediatricians and obstetricians to the Medicare provider base.

Some people are under the impression that the $100 or so per month Medicare premium actually covers most of the cost of the program. It doesn't, in fact in only covers around 25% of Medicare Parts B & D, Part A is entirely funded by payroll tax on non-enrollees.

Show me the financing and then we'll talk. And don't forget that diverting the contribution of the under 65s to their own coverage blows a hold in the financing of current enrollees, in practice Medicare for all means a big premium ON TOP of your current payroll tax. 

Show me the money.

by Bruce Webb 2010-03-23 09:44AM | 0 recs
RE: How long this time.

Options are really defined in Presidential Primary Season.  Single Payer was dead the moment the three major candidates didn't adopt it, and they paid no political price in Iowa and New Hampshire for doing so.

The Democratic Party is largely defined by what happens Iowa and New Hampshire.

Which is why the power those states have is obscene.

Single Payer won't happen until 2017 unless Obama loses the nomination in 2012.  If the economy double dips there is a shot he would lose a primary fight but I very much doubt it.

by fladem 2010-03-23 11:36AM | 0 recs
A realistic Medicare for All may be a wedge

Via some sort of opt-in on the pattern of the 2007 Kennedy-Dingell Bill

But the version of Single Payer on the table this year was a cruel joke. If you read it.

HR676 was never going anywhere and only starry-eyed F-Pups who never seemed to get around to reading its 30 pages of large type double spaced text ever thought it would. Elements of it could be introduced as part of a comprehensive plan to transition us to Universal Single Payer, but the notion that we could ever get the whole thing in one gulp was ridiculous, even if we agreed that total nationalization of health care was even a desirable goal.

This plan was always Fool's Gold.

by Bruce Webb 2010-03-22 11:56AM | 1 recs
RE: A realistic Medicare for All may be a wedge

What's a F-pup?

by FUJA 2010-03-22 06:21PM | 0 recs
RE: A realistic Medicare for All may be a wedge

firebagger, aka FDL single payer purist.

by fogiv 2010-03-22 10:25PM | 0 recs
RE: A realistic Medicare for All may be a wedge

since when are firedog lake people "single payer purists"?


they supported the bill when it started with no single payer in it. they supported it when the PO was weakened. They supported it when the PO was dropped the first time. Most supported it when it looked like it would only be snow-style "triggers". Most still supported it when it was just the Medicare age 55 thing, etc.

that's not a "single payer purist", or even much of a "purist" at all.

by jeopardy 2010-03-22 10:41PM | 0 recs
They supported HR676

Under the illusion it was 'Medicare for All'

And cast the Public Option as a sell-out. Before ostensibly rallying behind it even when they were still backing Dennis K who was still pushing HR676. Where were you last Fall?

by Bruce Webb 2010-03-23 09:48AM | 0 recs
RE: A realistic Medicare for All may be a wedge

not all of them are, but some are - which is what I preceived Bruce to be saying in his comment, particularly his reference to HR676 and the contingent of Denny K diehards at FDL.  I was simply answering FUJA's question. 

A little too defensive, no?

by fogiv 2010-03-24 01:27PM | 0 recs
RE: A realistic Medicare for All may be a wedge

All hundred thousands of them over there fall under your slur?  Mightly small tent you live in there.

by Jerome Armstrong 2010-03-23 09:21AM | 1 recs
Well if even one of those

hundred thousands had shown any sign of actually being willing to engage on the substance of HR676 rather than some gauzy slogans I might abjectly offer apologies. But nobody seemed to want to explain how nationalizing Walgreens and Pearle Vision Centers was actually going to be politically workable or how guaranteeing free long term care to everyone citizen or not was going to happen when that is not covered under Medicare today or how making supplementary insurance illegal or any of the other provisions of the bill made any sense at all.

HR676 proposed a National Health System far to the left of the British National Health Service or any other national health care program outside the old style Soviet bloc. Yet people still took its prime sponsor Kucinich (after its author Conyers deferred to leadership in August) seriously and held him up as some paragon of principle.

I gave the link, if anyone wants to write up a text-based defense that would explain how HR676 would ever have gotten more than 5 votes in the Senate I will be happy to post it at Angry Bear. Jerome put your political consultant hat on and read the text and tell me how you would sell unlimited free medical, dental, vision and long term care to illegal immigrants regardless of work history in any district except Barbara Lee's.

The regulars at FDL (who I don't think number in the 100's of thousands, certainly not anymore) very arrogantly took it on themselves to define who was the real liberals and who were sell-outs. And your adoption of the rather sneering 'liberal political wonks' shows you perfectly fine with that.

Well you know the old saying: "Lay down with Fire-pups---"

by Bruce Webb 2010-03-23 10:01AM | 0 recs
RE: Well if even one of those

It sounds like it would be the Kyoto vote all over again.

But, the whole reason I am bringing up the mandate is not to get into an argument over the merits of it, but just to point out the political risks are real with how its been concieved.

You'll see how it plays out.

by Jerome Armstrong 2010-03-23 11:26AM | 0 recs
RE: A realistic Medicare for All may be a wedge

let's see, if either you or jeopardy can point out where my comment aims to include all fire dog lake readers, users, or whatever in that statement, I'll donate a grand to the candidate of your choice.

now, since I'm a member of FDL, a more than occasional reader, and on Jane's mailing list and don't qualify as a 'single-payer purist', ya'll have already lost the bet.  I simply responded to FUJA's question:

What is an f-pup?
Considering the context of Bruce Webb's comment, that's what he meant. Remind me again, who's pissing in the tent?
by fogiv 2010-03-24 01:23PM | 0 recs
RE: A realistic Medicare for All may be a wedge


That's a loaded and encompassing reply to the question.

There are diehards like that here, on dkos, and throughout, I just want to see it avoided-- the sort of broad stroke here.

by Jerome Armstrong 2010-03-25 10:40AM | 0 recs
RE: A realistic Medicare for All may be a wedge

meh.  eye of the beholder. it's a direct answer to a question, worded specifically to convey the meaning and tenor of another user's post.  no more, no less.

maybe we should all just limit com to body language, lest someone gets bent.

by fogiv 2010-03-25 07:14PM | 0 recs
always a problem

from the get go, i thought it was a mistake to call it "health care reform". its always been about insurance. needless angst was generated because of that mistake.

by KoolJeffrey 2010-03-22 10:31AM | 0 recs
RE: always a problem

I think they figured that out... They are calling it Health Insurance Reform right now.

by FUJA 2010-03-22 06:22PM | 0 recs

Issuing mandates without a public option of some sort is huge mistake. In the end this bill will indeed end some careers.. One of my local congressman Steve Driehaus just ended his career. He wont be re elected over this.

by BuckeyeBlogger 2010-03-22 10:43AM | 0 recs
RE: Mandates

But think about it this way:  The public favors some sort of public option by > 60 % or so.  So in a year or so, bring up a debate specifically about the public option.  Make people vote for or against that on its face.  I don't expect the GOP to be chastened, but it does seem like a more comprehensible debate to have rather than "this 2,400 page monstrosity" (as the saying goes).

by the mollusk 2010-03-22 11:12AM | 0 recs
RE: Mandates

This is exactly why the House should get behind Alan Grayson and the Medicare Reform - it delivers good news to the seniors, and to everyone who would want to buy into Medicare.

I think its bill 4789, but it creates a de-facto public option.

by Trey Rentz 2010-03-22 01:42PM | 1 recs
Oh look who's suddenly for a public option

Mr. "You have to be bipartisan"

Driehaus gets the honor of writing a Majorie Margolis-Mezvinsky-like editorial in 15 years over another issue where he reminds Democrats not to listen to people like you and vote their conscious even if it costs them their seats because the country is better for him doing it.

Driehaus, after all, voted for the public option in November when you were screaming to scrap it to kiss Republican ass.

by ND22 2010-03-22 11:48AM | 2 recs
RE: Oh look who's suddenly for a public option

As usual your feeble mind missed the point which was we are mandating coverage but not providing for adequate and affordable access. All we did was push the uninsured into private coverage they cant afford. Want to lower costs and thereby improve access? How bout this, start with drug costs. Allow medicare and medicaid to negotiate drug costs. Reduce patent time for drugs. Set maxiumum prices (yes price control) on medications.Also invest more federal money into drug research. Even if the Federal Government too did the bulk of research and employed all those people, costs would be lower as we reduce the profit motive.

Enact real tort reform. Limit jury awards, put rules in place designed to limit frivolous lawsuits. Encourage the growth of not for profit hospitals, again discouraging profit motive in healthcare. Encourage preventive and evidence based medicine. Enourage change in how and what medical schools teach students moving back towards preventive medicine and away from symptom treatment. This bill doesnt achieve these goals sufficiently. Its a step in the right direction but doesnt sufficiently attack the problem.


by BuckeyeBlogger 2010-03-22 02:02PM | 0 recs
So I take it

you're behind Alan Grayson's bill?

Not that you'll ever answer the question straightfowardly, so good of you to come to progressivism so late after you've been shitting all over it for months.


by ND22 2010-03-22 02:23PM | 0 recs
RE: So I take it

I could support Graysons bill provided we, reduce patent terms on drugs, set price controls on drugs, allow medicaid and medicare to negotiate prices,  include and enact real meaningful tort reform. Also if we are going to open up medicare, we better improve payouts to physicians otherwise your going to end up with physicians refusing to see medicare patients



by BuckeyeBlogger 2010-03-22 06:55PM | 0 recs
RE: So I take it

I can't disagree... all that and more needs to be done.

by vecky 2010-03-22 07:12PM | 0 recs
RE: Mandates

We'll see.  Your predictions have been erroneous on several occasions.

by FUJA 2010-03-22 06:23PM | 0 recs
So what about HCR?

When do we try to address the ever-growing costs of dealing with for-profit pharma, medical equipment manufacturers, and hospitals?

by Flynnieous 2010-03-22 10:56AM | 1 recs
RE: So what about HCR?

And don't forget the need for some sort of rational discussion on how agri-business is handled in this country and what effects that is having on expensive and completely man-made chronic illnesses.

by the mollusk 2010-03-22 11:14AM | 1 recs
RE: So what about HCR?

That's a very good point. Other than from the First Lady, I have not heard much of a discussion on the prevention end.

by NoFortunateSon 2010-03-22 02:14PM | 0 recs
RE: So what about HCR?

Yeah, I'm in full-on "Omnivore's Dilemma" mode at the moment.

by the mollusk 2010-03-22 02:56PM | 0 recs
I was.

Then I lost my job.

Having to balance a budget, buying organic/locally grown was the first to be thrown overboard. Now I understand why poor nutritions plagues our lower income citizens.

I hope that an intelligent solution is found that adds prevention to the overall structure.

by NoFortunateSon 2010-03-22 03:09PM | 0 recs
If we find a lot of onerous stuff that needs changing

What will the Rethugs and their echo machine do with it.

I also wonder if the Wingnut "Sky is falling" rhetoric is going to fall flat now since the bill has past and Grandma hasn't been sent off to a Death camp and Hugo Chevez isn't meeting folks in their Dr. offices. Will the TM play to the Right or the Left on these issues?

by eddieb 2010-03-22 11:15AM | 0 recs
RE: If we find a lot of onerous stuff that needs changing

Don't bet on it. Remember the wingnut rhetoric on FEMA concentration camps and a 'Obama Army' (i.e: Americrops expansion)? Well, didn't come to pass but they just moved on to other things to scream about.

by vecky 2010-03-22 11:51AM | 0 recs
Fear over facts

I agree with Vecky.

For Republicans, this is such a visceral, fear-based response. Facts are irrelevant, and that's what Democrats often don't understand.

You could literally offer all the proof in the world that there is no such thing as death panels, and these people would still believe it. It would be like taking a person who believes in ghosts, putting them in a spooky house, and then rationally expalining to them there is no scientific evidence for ghosts.

The people who will benefit from the light of facts here are the Independent voters. These people, if they had been so fooled, will see that all the GOP offered were lies. You're never going to convince the fringe.

by NoFortunateSon 2010-03-22 03:14PM | 0 recs
RE: If we find a lot of onerous stuff that needs changing

Well the Death Camps don't start for 4 years... so It will come up in Midterms then.

by FUJA 2010-03-22 06:25PM | 0 recs
Single Payer is an Individual Mandate

Something us Liberal Political Wonks recognize but one which FirePups frantically chase their tails trying to get their minds around.

Jerome what part of the 'Universal' in 'Universal Single Payer' don't you people get? FirePup, OL, MyDD logic only works if you assume that all governmental regulation is inherently futile. Well shit there goes the New Deal and for that matter Cousin Teddie's Trust-Busting a generation earlier.

The progressive income tax is an individual mandate, so is the payroll tax that funds Social Security and the one that funds a Medicare system that funnels the overwhelming percentage of its ultimate proceeds to private sector medical providers.

The best way I can describe this visceral opposition to the individual mandate coming from the Left is Procrustean Manichaeism, a determination to see Evil no matter what logical limbs have to be stretched or cut off.

by Bruce Webb 2010-03-22 11:44AM | 1 recs
RE: Single Payer is an Individual Mandate

You really don't understand the difference between a government run public solution and a for-profit corporate solution?


by Jerome Armstrong 2010-03-22 12:27PM | 1 recs
RE: Single Payer is an Individual Mandate

I think what he's trying to say is that the left should unify instead of backbite. That said, the comment is a circomolocution.

by Trey Rentz 2010-03-22 01:41PM | 0 recs
RE: Single Payer is an Individual Mandate

I guess I could have explained further that a public option, in order to pass in the US, would not have a mandate along with it be in the public program-- people would be able to opt-out and continue buying private insurance if they wanted too. Wala, no mandate!

With this, we get the worst of both worlds-- its a mandate, and its through for-profit corporations.

I can understand the exasperation of realizing the futility of trying to argue that's a good route to take.

by Jerome Armstrong 2010-03-22 03:27PM | 0 recs
RE: Single Payer is an Individual Mandate

Your assumption is that people have no problem being forced to buy insurance, it's only the notion of having to buy it from those evil insurance companies.  I think there is a limited subset of people who have that as their focus.

More realistically, I think most people want affordable insurance.  If they can get affordable insurance from a for-profit company, most folks won't chafe at the notion that their monthly premium is being used to stoke the fires of capitalist oppression.  By the same token, if someone doesn't consider the public option affordable (and I think we're all guilty of assuming that of course it will be affordable, the same way one might assume a pony), they're not going to be any happier about the fact that at least they're not being gouged by a private company.

This last point I've said a million times, but I'll say it again: the vast majority of people who dislike the mandate are already insured.  The mandate is not going to affect them; they merely object to the principle.  It is doubtful that very many of them will choose to vote against Democrats based solely upon a principle.

by Steve M 2010-03-22 04:52PM | 3 recs
RE: Single Payer is an Individual Mandate

I did some math on the mandate to see if it would apply to me (I have employer coverage btw).

Lower avg. cost of an individual insurance policy here ~ 3,600$ a year (guesstimate, I went online and did a quick search). So since I don't make $45K a year the mandate doesn't hit me (more than 8% of income - gross or net?).

But what if it did? Say I made $50K a year and was mandated to buy insurance... would I still do it? Seems it would be cheaper to pay the $750 fine and purchase insurance on my way to the operating room if it ever came to that....

by vecky 2010-03-22 07:22PM | 0 recs
RE: Single Payer is an Individual Mandate

Had a conversation with someone that has been following this and knows the bill today. I have not been as much, so it was a real education. I asked something along this lines.

You don't pay each year, it just means you owe the IRS for all the years you haven't paid (& their crazy penalties I would imagine). It would get tacked onto the amount of your policy going forward, once you did sign up. If you don't have the insurance going in, you owe the bill for the the operation. So, no like gaming.

by Jerome Armstrong 2010-03-22 07:32PM | 0 recs
RE: Single Payer is an Individual Mandate

Well, that is interesting... so I guess that is a dis-incentive to go without insurance, plus side-steps the possibility of going to jail for not paying the fine. The longer you game the system the bigger the 'gotcha' becomes when you actually need it.

Only here in the states would they dream up such a system. I'm both sickened and impressed.

by vecky 2010-03-22 07:59PM | 0 recs
RE: Single Payer is an Individual Mandate

I don't believe for a second anyone is going to jail over non-payment of the fine. 

by fladem 2010-03-23 02:03PM | 0 recs
RE: Single Payer is an Individual Mandate

Well turns out you can't. The legislation explicitly rules out any criminal penalties/liabilities or even levies for non-payment. It's essentially unenforcable.

by vecky 2010-03-23 02:19PM | 0 recs
RE: Single Payer is an Individual Mandate

I don't really know how things work in guaranteed issue states... but I'm pretty sure you can't buy insurance on the way to the operating room, even if it's guaranteed issue.

by Steve M 2010-03-22 07:40PM | 0 recs
RE: Single Payer is an Individual Mandate

I didn't mean literally...  say I go to the doc and he suspects cancer or diabetes or something. I pop off to the Local Insurance Co., buy a plan, get all the tests paid for, then drop the plan when I'm well again.



by vecky 2010-03-22 07:56PM | 0 recs
RE: Single Payer is an Individual Mandate

Well, it is pretty silly to assume that every catastrophic medical condition is something you're going to get advance warning of.  What if you get hit by a bus?  This is not a good strategy.

by Steve M 2010-03-22 08:25PM | 0 recs
RE: Single Payer is an Individual Mandate

I'll never do it - my mum raised me to be risk averse. But there are people who choose to go uninsured now - I know a couple. I was considering it from their shoes as it were.

What Jerome posted above makes some sense though. It's even sort of diabolical.

by vecky 2010-03-22 08:30PM | 0 recs
RE: Single Payer is an Individual Mandate

"Seems it would be cheaper to pay the $750 fine and purchase insurance on my way to the operating room if it ever came to that."

Somehow I doubt that a traumatic brain injury suffered in a car crash ten minutes before you showed up at the insurance office is going to qualify as a "pre-existing condition". Or that you will be in the position of filling out even a brief sign-up form or have time to do so "on my way".

And oddly enough some people like to consult their doctor on a routine basis so that your first sign of trouble is not a massive stroke, heart attack or anal bleeding from that undiagnosed colon cancer.

And to get back to the point expressed in the subject line. The default position of the FDL folk is some form of Medicare for All. Which is for all practical purposes an individual mandate. Sure you don't have to actually enroll or utilize Medicare but if you earn wages or are self-employed you have to pay in. Which makes the Glibertarians crazy. But why on earth would self-styled progressives buy in to that logic?

by Bruce Webb 2010-03-23 10:15AM | 0 recs
RE: Single Payer is an Individual Mandate

I honestly hope they find this law to be unconstitutional. For me, and I've been uninsured for five going on six years now, this is simply creates more problems for me. Not only can I not find employment, I am now being forced to do business with corporations that have ruined my life.

I lost everything I own. My house, my life savings and you don't think I am bitter. I worked ten years on Wall Street pulling 70 hour weeks only to see everything I worked for get destroyed because I became uninsurable. I want nothing to do with corporations. Nothing. Now the Democrats want me to cozy up to an insurance company. Fuck that noise. Fuck it. Why would I want to give any money, even if it comes from the public treasury, to an insurance company who tried to kill me?

To get medical treatment, I had to become a guinea pig. Even then I only get the medication I am on until it becomes FDA approved, then I am back to square one. No corporation will get a dime of my money. Not a fucking dime. I want my house back, I want my life savings back. I will not do business with those who chose to pass a death sentence on me. 

That the bill now prevents insurance companies from denying coverage based on pre-existing conditions is great but that doesn't mean that insurance companies can't raise prices.

Nor do I believe that given my current financial situation, and I live well beneath the poverty line - I made $8,000 last year, that somehow subsidies are going to cover me. I just don't buy that. I was adamantly for a public option because in the end my life depends on it. My life savings are gone. I was driven into poverty by Blue Cross who denied me coverage arguing that I had a pre-existing condition. 

Unless Mark Leno here in California is able to pass the single payer plan, then emigration is looking like my best option even though that too likely is a short path to suicide. I am damned either way. Perhaps at least overseas, I am employable again.  

I've thought long and hard about making details of my own personal situation public, but at this point I have nothing left to lose.

This is my last post for a while, perhaps ever. I just can't do this anymore. I can't defend a party that would sell me out to a corporation. The betrayal is very very hard to swallow. 

by Charles Lemos 2010-03-22 07:49PM | 1 recs
RE: Single Payer is an Individual Mandate

I agree with you re: the evil insurance companies (especially after fighting with them almost every week for the last year+ about my dying grandfather's coverage).

But please try not to let hate take the rest of your life away. It's not going to "get them back" at all if you take your life. But you always have a chance to make a positive difference if you live.

I hope you can try to find some worthwhile meaning or purpose for the time you have available on this Earth.

by jeopardy 2010-03-22 08:43PM | 0 recs
RE: Single Payer is an Individual Mandate

Also, please note that if health insurance costs more than 8% of your adjusted income, you are exempt from the mandate.

So if your financial situation is dire, you will not have to give anything to the insurance companies or pay a fine.


by jeopardy 2010-03-22 08:45PM | 0 recs
RE: Single Payer is an Individual Mandate

He'll also be eligible for Medicaid... something that a lot of people were not before.

by vecky 2010-03-22 09:08PM | 0 recs
RE: Single Payer is an Individual Mandate

Charles, I really like your posts and I want to share with you my situation. My wife was in a similiar scene - she became a 'pre existing condition' case for the insurance companies - our premiums were so high that she - literally - left the country to get healthcare.

In face, she's out there now. Getting treatment. It was cheaper to fly halfway around the world than it was to go to the hospital in our neighborhood - and we have some really nice hospitals, and doctors.

In the end, Charles - the Alan Grayson Bill does exactly what we need it to do vis a vis public option -

I am perfectly willing to pay a fair premium. But not 1200 dollars a month for a single person or something ridiculous like this.  And my wife, to be perfectly honest - is in all actuality fairly healthy. Her life, perhaps like yours - depends more on fair treatment, preventative medicine and the like. Strong therapy and a consistent cure to her condition.

What is the difference, between a public option - and Alan Grayson's Buy in-to Medicare. For us. Almost none. In a full public option I would have to pay additional taxes. In Alan's Medicare bill, I would have to pay a premium. Either way, I am perfectly happy to pay my share for a fair rate.  What hurts is to see how much they are charging us now - and for what little we are going to get - far too many 'pre existing conditions' and benefits for doctors +not+ to cure you.


Charles. Get behind Alan Grayson and you will be ok. I imagine that bill can go into effect very. very quickly.  And count your blessings old friend.


by Trey Rentz 2010-03-22 11:13PM | 0 recs
I wish you would stay

I have truly enjoyed your posts...Given the breath of your knowledge, and the carefree skill with which you deploy  your wits, I am stunned by your personal situation that you hint at here.


Perhaps you can write a semi personal post, to give your fans some more insight.


by Ravi Verma 2010-03-23 01:54AM | 0 recs
RE: Single Payer is an Individual Mandate

If this Bill is unconstitional then about half the Great Society is as well.

The argument that this Bill is unconstutional is based on 10th Amendment nonsense that only hard core Federalist Society members buy.

The fact that it is repeated on liberal sites never ceases to amaze me.

by fladem 2010-03-23 12:04PM | 1 recs
RE: Single Payer is an Individual Mandate

I think you are 100% wrong with your assumptions there. I've encountered quite a few young libertarian democrats that have done with the Democratic Party over this deal.

by Jerome Armstrong 2010-03-22 09:05PM | 0 recs
RE: Single Payer is an Individual Mandate

Imagine how they would have reacted to Single-Payer!

Hey, it's a Big-Tent for a reason.

by vecky 2010-03-22 09:09PM | 1 recs
I had the same thought too

They're upset over the government intrusion of the mandate, but shouldn't they be equally upset over a public option, where, in the libertarian view, government would be an unfair or even predatory competitor in the free makret?

by NoFortunateSon 2010-03-23 01:08AM | 0 recs
RE: I had the same thought too

And the mandate is not a true 'mandate'. It only applies if you want to be a part of the system. If you want to live out in the boon-docks and never ever buy insurance you don't have to bother about paying it.

Most people are thinking of the mandate like an actual order - a directive. Rather it's a financial incentive. Those who choose not to buy insurance (< 8% income) are taking a risk, so when they do buy into the regulated system they have to pay the fine to get in. But if they don't want to play they don't have to pay.

by vecky 2010-03-23 01:21AM | 1 recs
Well if they're really libertarians

then a public option or single payer would've exiled them from the party too.

by ND22 2010-03-22 11:41PM | 1 recs
Beware the double edged sword of the libertarian democrat.

My understanding was that the mandate is necessary to increase the insurance pool large enough to permit the ban on recissions, lifetime/annual caps, and preexisting conditions. If you drop the mandate, these benefits of HCR begin to unravel.

The libertarian democrat in me does blanche at the thought of the government forcing people to buy something. The progressive in me isn't upset at the mandate, but that what I'm forced to acquire is a product from a for-profit corporation.

So in comes the public option, which I wholly support. People who are mandated now have a government run option they can acquire as a freedom from for profit corporations.

But I fear many progressives may make the mistake of projecting their own desires of a completely public system onto those of the libertarian democrats. A public option too generous runs the risk of turning government into a predatory competitor on private health insurers.

If intellectual honesty governs, shouldn't that prospect equally unnerve the true libertarian democrat?

by NoFortunateSon 2010-03-22 11:55PM | 0 recs
The key

is the effectiveness of the subsidies in making insurance affordable.  If they are, I don't think people are really going to care where it comes from.



by fladem 2010-03-23 01:59PM | 0 recs
Death by CBO

What's interesting too, is how Democrats in DC view the liability of the mandate as the lesser of evils. What was more important was to get a CBO score that reduced the deficit, hence the mandate to get that number.

I thought that was the excise tax. In the CBO scores the mandate was related to number covered not the deficit. It raised very little to almost no money.

by vecky 2010-03-22 11:46AM | 0 recs
RE: Death by CBO

Good point, I got that exactly wrong:

But the point being that D's were more interested in a CBO score than the political consequences of having a mandate to buy for-profit insurance.

by Jerome Armstrong 2010-03-22 12:35PM | 0 recs
RE: Death by CBO

Yes very true. The CBO weilds huge legislative power. Waxman was complaining about that the other day... I think some wings will be trimmed.

by vecky 2010-03-22 01:01PM | 0 recs
RE: Death by CBO

Right... but the mandate is all about the pre-existing conditions.   It won't lower the costs, it will maintain the costs.  Without it, if people could get insurance without ever paying into the pot then they would buy it when they are sick and cancel when they are healthy.  In that case, premiums would sky rocket.


The mandate is a necessary evil... funny I don't see the GOP railing about car insurance mandates...  mandated insurance through for-profit companies.    But I agree that passing Grayson will neutralize any Mandate arguments and will be immensely popular.

by FUJA 2010-03-22 06:31PM | 1 recs
Community Health Centers et al

We may have community health centers but where are the doctors for them going to come from? The payment schedule for them is too low to actually attract enough doctors. Its the same with Medicaid. We're going to have a major expansion of Medicaid but, as is the case now, a strong majority of doctors  refuse to accept Medicaid patients because of the low reimbursement rates.

by carter1 2010-03-22 11:51AM | 0 recs
RE: Community Health Centers et al

Medicaid reimbursement rates do go up temporarily (to Medicare levels I think) for primary care physicians.

by vecky 2010-03-22 12:27PM | 1 recs
"There will be no cooperation for the rest of the year,"

And that would be different, how? 

When has McCain actually cooperated with us on anything last year.  I certainly can't think of anything!  The win gives the white house more clout, actually... 

As for the mandate... the mandate plus subsidies has actually polled very well.  Certainly, it can be used as a political scare tactic, but it negatively affects very few.  If gallup is right in that 15% of Americans are uninsured (I think that's a low number), most of those actually WANT health insurance, so only a few people would be cranky about it in the long run... but, it makes good political theater...

by LordMike 2010-03-22 01:21PM | 1 recs
RE: "There will be no cooperation for the rest of the year,"

"As for the mandate... the mandate plus subsidies has actually polled very well."

Ah, but you forget the rest of the numbers (we can wade through this but I take it you recall), that once the IRS enforced penalties are brought up as being alongside the mandate, the support plummets.

by Jerome Armstrong 2010-03-22 03:33PM | 0 recs
RE: "There will be no cooperation for the rest of the year,"

Then goes back up when the mandate is linked to guaranteed issue (no pre-existing condition exclusion).

Personally I don't think it's a big deal. The mandate is pretty weak and the 8% of income exclusion means that it will only hit the upper-middle class, 96% of whom already have health insurance anyway. If the GOP or the Dems repeal it, no biggy. Eventually they'll have to deal with folk trying to game the system somehow.


by vecky 2010-03-22 04:35PM | 0 recs
RE: "There will be no cooperation for the rest of the year,"

So it's more of a perception issue than an actual issue.     Well Obama is a hell of a salesman, if anyone can change some minds, I'm betting he can.  Besides, the penalties are small to start, and I would be 99% of people would never be affected by the mandate.


  And I don't see it as a bad thing to create 16 to 18,000 new jobs.

by FUJA 2010-03-22 06:33PM | 0 recs
Fortune favors the Brave

There is a bill on the floor of Congress right now - as Jerome pointed out earlier - which accomplishes the public option lock stock and barrrel , right out of the gate. Focus should be given it. 

It is Alan Graysons - House bil 4789 - Medicare upgrade.  This creates a national health service that people can simply buy into, at a good price.

This would cover anyone and everyone who wanted coverage.


And it's on the floor now. Why wait a year? This was a +victory+ last night, and no reason why you can't follow it up. This bill goes through the works - and everyone will be happy.


by Trey Rentz 2010-03-22 01:39PM | 1 recs
RE: Fortune favors the Brave

Why wait a year?   Filibuster reform.  I'm not sure you will be able to attract the one or two GOPers needed to get this to pass cloture... assuming Lieberman is a no.   If we can, then hell yes.   But reality may not be with us.

by FUJA 2010-03-22 06:35PM | 0 recs
RE: Fortune favors the Brave

Because the Alan Grayson bill reflects the strong sense of fiscal discipline that his deeply red constituency demand.  Alan Grayson has crafted legislation that is based on a solid business model. We are buying into Medicare.

We are contributing to a fund. It is only allowing a sort of free enterprise and enabling Medicare to expand and fund itself through the individual business decisions of the American people. Nothing more.


The GOP party is dying fast. If they don't grab on to something as conservative as this - they deserve to be trampled underfoot by the Tea party.


by Trey Rentz 2010-03-22 11:16PM | 0 recs
A first significant step

But let's not ahead of ourselves and uncork the champagne just yet. The House Democrats delivered, the outcome of the bill was never in doubt once Nanacy Pelosi got behind it, the House gets things done, period.

Now comes the sticky part, which is passing the fixes through reconciliation in the Senate. The Senate has to deliver, and time and again it has failed. For the Senate to deliver by reconciliation two thinsg need to happen: 1) Enough Democratic votes need to be corralled, and for those standing in the way let us have primaries, and 2) if there is an objection raised by a Republican parliamentarian, the administration should muster the courage and have the Vice President overrule that objection.

by tarheel74 2010-03-22 05:44PM | 0 recs
RE: A first significant step

Frumin was a Democratic appointment before he was removed in 1995 for Dove.   Frumin was reappointed in 2001 by Lott.   He's a REALLY smart guy and does his job well.   I doubt he plays the politics one way or another and instead answers to the best of his opinion.

by FUJA 2010-03-22 06:39PM | 0 recs
RE: A first significant step

If he plays politics here he's out of a job... I hope he knows that.

Of course it's all politics - if the GOP ever takes control of the Senate he'll be out of a job anyway.

by vecky 2010-03-22 07:14PM | 0 recs

Yeah, I'm fairly certain the virginia law is just for show and in a showdown Virginia will be bitch slapped if the Government wants to take it on.  Of course given the activist SCOTUS, you never know what constitutional precedents they will violate, but following the law NULLIFICATION is not legal and Virginia and the other states have no legal standing.   

How many people actually understand that the pre-existing conditions is only possible through a mandate?    Apparently not enough.  Because eliminating pre-existing conditions and not having a mandate will send premiums skyrocketing.

I doubt this is going to be as big of a deal as you do Jerome...   Especially given it doesn't go into effect for 4 years.    They'll huff and puff but again, 2010 is going to be ALL ABOUT JOBS!!!!    The Dems hopes are pinned on unemployment right now.   The better the numbers, the better they will do.

However, if I am wrong on a backlash this year or next (now we might see a backlash a few years from now), then hopefully it will create an opening for Grayson's bill, which needs to be STEP 2 in this fight.

by FUJA 2010-03-22 06:13PM | 1 recs
RE: ...

Yeah there will be a media blitz to create the illusion of a backlash because the lobbyists have already paid for it through their cute little media buying firms out there. You could see all the buys going in - the editors get the calls and away they go, distorting reality-


Having said that it is entirely unsustainable since the American people really wanted this legislation and they finally got it and they're happy that they did.  They're only pissed off that Max Baucus turned the senate bill into something they didn't recognize. The American public understands things like - the public option. They don't want to hear a long list of benefits that go on and on like - they'll get subsidies to buy from private insurance companies. It sounds too much like a government bailout and a cash cow.

However, in the end, the American public are going to decide on the backlash issue and the reality is that even if the jobs don't come this year - that almost guarantees that they won't be wanting to drop their insurance.

And so. Yeah. No real backlash. A fake one. But not a real one. Two months, three months tops if at all. In the meantime support for healthcare reform will grow.



by Trey Rentz 2010-03-22 11:21PM | 0 recs
You can't get everybody in unless everybody pays.

As Paul Krugman repeatedly points out:

In order to get everybody covered with guaranteed issue (no pre-existing & no recissions), then everybody has to be paying into the system. That means a mandate. It also means sliding scale or subsidies for lower income people. You could get it cheaper by socializing insurance (single payer) and using a progressive tax, or you could get it by forcing people to buy private insurance.

Universal insurance means risk sharing by everybody. The free-loader problem is that healthier, younger people are willing to take their chances rather than pay, meaning that some portion of them will get sick, go to the hospital and have others pay their bills. 

Yeah, it sticks in my craw to be forced into expensive, private insurance. Maybe I don't like it on ideologically grounds, but from a practical standpoint, the fiscal argument is much more objective: Private insurance is 30% more expensive than socialized insurance.

by MetaData 2010-03-23 10:08AM | 0 recs
Polling on the mandate

is somewhat vauge.  If you look at, you will find two sets of questions:

1.  Should people be forced to buy insurance if there are susbidies for people who cannot afford it?

This polls around 55-35 positive.

2.  If you ask if people should be "fined" if they don't have insurance, by about 60-20 they are less likely to support HCR.  But the question is only included as part of a list of questions that ask people if they are more or less likely to support HCR, and has never so far as I have found been included the word "fine" in questions like the one above..

I hear people say the mandate is unpopular, but in my experience they seldom attempt to look at the actual polling, or alteratively they cherry pick polls. As in most things most people are simply interested in asserting that their own position is more popular rather than actually consulting the evidence.

by fladem 2010-03-23 12:16PM | 1 recs
RE: Polling on the mandate

That's the poll that I have referred to in the past, in regards to the fall of support when a fine or penalty is mentioned. I think too, that 'fine' is pretty weak tea compared with the frame of 'IRS enforcement'.

by Jerome Armstrong 2010-03-25 10:46AM | 0 recs
no way to repeal the individual mandate

Both Republicans and FDL have identified repealing the individual mandate (while preserving the popular reforms) as a top political priority. But the Republican funders, the Chamber of Commerce and the insurance lobbies for instance, will not support the mandate repeal. So there is no way the Republicans will repeal the mandate. Obama has put the Republicans in a box on HCR. Ezra Klein ( ) has described this in a bit more detail.

FDL is being a bit more dense, as commenters above point out. Universal coverage requires an individual mandate, and universal coverage is the key to all of the other progressive reforms. In the U.S. political system we can't control the cost of health care, or move to single payer, unless we build on top of universal coverage. This was Hillary Clinton's point in the primaries, and why Obama immediately adopted her approach once he was elected.

Republicans have no way forward on HCR, other than lying. Democrats have a number of options for fixing reform before the mandate takes effect in 2014, including medicare for all or a public option.


by tib 2010-03-24 11:15AM | 1 recs
RE: no way to repeal the individual mandate

I agree on their being little likelihood of a repeal. There is a possiblility that SCOTUS goes radical, but they are so pro-corporate, and this bill, as you state, has had full Republican support in the past, so it may just be it. Its on the way to SCOTUS, probably via the Virginia Republicans passing the opt-out here already.

by Jerome Armstrong 2010-03-25 10:43AM | 0 recs


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