Passing A Health Insurance Assistance Bill

As Jeralyn notes, Beltway Dems, eager to declare "victory" on the health care issue are preparing to deal away the public option. What will be interesting to me is what will they come for next from this "reform" proposal? It seems clear that the Beltway Dems are prepared to give away any and all parts of the proposal in order to get 60 votes + Olympia Snowe. Reconciliation will only be considered if progressive Democrats say no to the giveaway.

The Village Wonks and their allies have never cared about the public option (a perfectly reasonable position) and are willing, no, eager, to jettison the public option. That is their right. But for Democrats who believe that the public option is the only worthwhile reform in the proposal, this is an unacceptable capitulation. It is time to consider forgetting the "reform" part of this and just focus on passing the "assistance" part of the proposal. More . . .

As I have written before, there are two aspects of this bill - one seems undeniably positive - the expansion of financial assistance to the less well off for health insurance. We can all, I believe support these initiatives. Thus, the expansion of Medicaid and the provision of financial subsidies for the purchase of health insurance is a good thing (the subsidies of course raise the Stupak issue and it may be that this would be sufficient to oppose these subsidies.)

The other aspect is "reform" of the system. The vaunted exchange, community ratings, the no pre-existing conditions, etc. The Village Wonks have high hopes for these provisions. I am confident they are meaningless. But I have no objection to them.

The final piece is the individual mandate (noteworthy is the fact that there is no employer mandate.) With a meaningful reform bill, the individual mandates seems worthwhile and worthy. When the bill lacks the potential for meaningful reform, it is not supportable. The Village Wonk view is that the reforms offered, without a public option, are worthwhile. I disagree. Therefore, I oppose the inclusion of the individual mandate.

One final point - I believe the funding mechanisms dependent on increasing taxes on the well off is progressive and worth supporting irrespective of the health assistance or reform initiatives. Other funding mechanisms (the excise tax) are not progressive and I oppose it.

So if there can be no public option thanks to the unwillingness of the Beltway Dems to use reconciliation, then it is time for progressives to negotiate the bill as a health assistance, not a health care reform bill.

A health assistance bill should and can include - increases in Medicaid eligibility and voluntary subsidies for the less well off to purchase insurance. A health assistance bill CAN include the Village Wonk regulatory "reforms." A health assistance bill should NOT include regressive financing mechanisms like the excise tax and should include progressive taxation on the well off.

A health assistance bill can not include a tax on the less well off who can not pay for health insurance. The mandate tax must be stripped.

Such a compromise should satisfy the Obama Administration (The "passage of any bill is victory" guys), the Village Wonks, the anti-public option people and is acceptable for voting Aye on for progressives as it does more good than harm.

It is not reform of course. But it is assistance. and that is better than nothing. Unlike the likely "health care reform" proposal that will emerge from the Village.

Progressive Dems need a strategy to get to a bill they can support. One is to insist that reconciliation be employed to get some semblance of reform passed. The other is to bargain for a health assistance bill that does not kill the chances for real reform down the road while helping the less well off in the short term.

Speaking for me only

< Sunday Night Open Thread | Mandates, Subsidies, The Public Option And Stupak >
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    How about (5.00 / 2) (#1)
    by Ga6thDem on Mon Nov 23, 2009 at 07:16:27 AM EST
    just walking away? This bill doesnt get better it only gets worse with each "compromise".

    Some people (5.00 / 2) (#43)
    by CST on Mon Nov 23, 2009 at 10:26:14 AM EST
    can't afford to just "walk away".

    Like anyone with pre-existing conditions or serious health problems.

    Also I am not really sure I see what walking away will accomplish.  It's not like that has worked in the past.  There is no indication that not passing a bill will make anyone more likely to pass a bill in the future.  In fact, I'd argue that passing a bill with incremental change is more likely to promote more change in the future, than passing nothing.

    The key to this all will be "do no harm".  The only provision in the bill that I see as "harming" is the individual mandate.  Other than that, whether you call it reform or assistence, there are some very important changes being proposed.  As to whether those changes are worth an individual mandate, to that I'd say, it's hard to tell, and depends on what is in the final bill.

    What I don't see is how scrapping the whole thing is supposed to help anyone.  It seems a lot of people just want to see the Dems in congress lose, which might be nice for "I told you so's", but I'm not sure how it's supposed to help.  All that will get us is a bunch of Republicans.  That doesn't seem likely to usher in a newer, better version of reform.


    I agree (5.00 / 1) (#45)
    by Big Tent Democrat on Mon Nov 23, 2009 at 10:29:02 AM EST
    Scrap the parts that will impede reform in the future. Namely, the mandate.

    Arguably, all of the reforms (5.00 / 1) (#48)
    by andgarden on Mon Nov 23, 2009 at 10:51:08 AM EST
    without a public option and a mandate will create a worse system than before: the insurers will jack up the price to cover the risk. But if the price is borne mostly by the government through subsidies, we could possibly get support to bend the cost curve later. . .

    In any case, I think as a matter of political survival, Congress must pass a public option.


    All these A-holes have been arguing (5.00 / 1) (#53)
    by Militarytracy on Mon Nov 23, 2009 at 11:46:47 AM EST
    fiscal responsibility though....how do they justify this?

    Fine (none / 0) (#67)
    by Ga6thDem on Mon Nov 23, 2009 at 08:21:30 PM EST
    but you can write a bill that changes that without all the other garbage cant' you>

    At What Price? (5.00 / 2) (#2)
    by azhealer on Mon Nov 23, 2009 at 07:36:48 AM EST
    even before the crazy Dick Morris piece today, governors- including Dems- as well as very progressive Senators have been screaming about the expansion of Medicaid on state budgets.

    There is zero question that, here in Arizona, for example, mandated increased Medicaid spending will come directly out of public education and public safety.

    BTD -- I am with Ga6thDem --- progressives are better telling our senators and congressmen to walk away... focus on a massive jobs bill... so voters will give us that extra cushion next November to get this in 2011.

    Except that (5.00 / 1) (#25)
    by gyrfalcon on Mon Nov 23, 2009 at 09:50:50 AM EST
    there's extra federal money in the bill to pay for the increased Medicaid for states that are below the mandated level.

    Dick Morris is a congenital liar.


    read the bill (none / 0) (#30)
    by azhealer on Mon Nov 23, 2009 at 09:53:54 AM EST
    the match is 90/10

    CBO says $33 billion in state spending for House and $25 billion in Senate.

    DEMOCRAT Gov Bredesen (TN) -- says it will bankrupt his state.

    please have your facts... I am not parroting morris, who gets some facts wrong.


    Meh (none / 0) (#34)
    by andgarden on Mon Nov 23, 2009 at 09:59:16 AM EST
    I don't know what Alabama has to use (none / 0) (#66)
    by Militarytracy on Mon Nov 23, 2009 at 05:28:57 PM EST
    They used anything extra in their education budgets to cover this year's shortages.  My son's teacher didn't even have ink for the classroom printer.  I spent a $100 on two ink refills and threw in another $40 in cash.  She just started teaching this year and the state had to raid the money that went to teachers' classroom essentials.  The classroom only has one computer too and there is supposed to be three.  Fort Rucker gave them a used one that has been wiped but it has no software now and with only one tech person for the whole district........it is going to be awhile before that one is up and running too.

    How is the COBRA.... (5.00 / 1) (#3)
    by EL seattle on Mon Nov 23, 2009 at 08:13:34 AM EST
    ...subsidy program working out?  Does anyone here know?  

    That's a temporary program that's in place right now that I think is helping a lot of folks hold on to their insurance right now.  It could be expanded and adjusted to include more people right now.  How many people feel they can afford to take advantage of it right now?  How difficult would it be to apply the funding ideas that they're talking about for a 2014 program to an expansion of the COBRA plan in 2010?

    If insurance has become the only option, I think they could expand Medicare "temporarily" too if they wanted to, with the goal of getting moving those folks without insurance to the Medicare stage until they can afford the improved COBRA subsidy stage.  Once they can afford to pay more of their insurance cost, they's be moved to a reduced COBRA category and then off the subsidy completely.

    My greatest concern that there are now a lot of policy folks who are trying to re-invent wheels, rather than even take the time to recognize area where wheels might be working right now and taking advantage of and building on those examples.

    There's a subsidy program for COBRA? (5.00 / 2) (#10)
    by Anne on Mon Nov 23, 2009 at 09:13:34 AM EST
    I had no idea.  

    My understanding of COBRA is that it allows one to continue one's employer-based insurance for up to 18 months, as long as one pays the entire cost of the premium; that can be prohibitively expensive, especially when all one is getting is an unemployment check every two weeks.

    The whole reinvention-of-the-wheel thing is happening because it's the only way to protect the insurance industry's profits and keep Wall Street happy (Goldman Sachs is up to its armpits advising major insurance companies).

    If it was about helping people, the answer has been obvious for years, so the fact that it hasn't been done should tell you everything you need to know.


    It was part of the stimulus bill. (none / 0) (#12)
    by EL seattle on Mon Nov 23, 2009 at 09:21:54 AM EST
    Here's a short rundown from earlier this year:


    I haven't heard how many recently unemployed people are taking advantage of the program, or how many don't feel they can afford even 35% of their insurance cost.  I think that it would be interesting to find out.


    It's all coming back to me now - (none / 0) (#16)
    by Anne on Mon Nov 23, 2009 at 09:32:42 AM EST
    thanks for the link.

    The problem I have with subsidies in general is that they do not seem to address whether the cost of the insurance is fair to begin with.

    And I still do not understand the obsession with employer-based insurance, especially in this economy, where people continue to lose jobs.  Or in the context of people not having the freedom to leave jobs they hate, or pursue their dream job, because they are handcuffed to their employer-based insurance.


    Yes, in a perfect world, COBRA (none / 0) (#20)
    by Cream City on Mon Nov 23, 2009 at 09:40:19 AM EST
    without subsidies would be affordable for the unemployed.  And it would be a lot better-run, too.

    You, of course, are well aware of how imperfect is this world, especially this country when it comes to health insurance, and especially now for the unemployed.  So unless and until the larger problems with COBRA are fixed, continuation of the subsidies are desperately needed.  Or more of the unemployed will go hungry, be homeless, lose their children . . . or drop out of school, where they are retraining for different careers, and then they will lose hope.


    I did not mean to suggest that the (5.00 / 1) (#51)
    by Anne on Mon Nov 23, 2009 at 11:00:31 AM EST
    COBRA subsidies should end, not at all; I know they have been a godsend to those without work and with no chance of getting insurance on their own.

    What I would like to see is an end to just throwing the insurance industry whatever money they say they must have - it's going to happen again with the subsidies people will be eligible for to help them purchase insurance through the exchange.

    It would be one thing if people were getting value commensurate with what they are paying, but they're not, and I'm not convinced that that is likely to change.  People will have their bright, shiny insurance policies and still not have the CARE they need.


    It is about to run out (5.00 / 2) (#11)
    by Cream City on Mon Nov 23, 2009 at 09:18:41 AM EST
    as I know well from my daughter, who is panicked about it.  She and her fiance both have been laid off and are back in school, but she will have to give up her car (and school), and he will have to sell his (and his son's) home and more if they do not get a continuation of the subsidy -- because both have pre-existing health conditions, too.

    Learning from her poli sci class, and with a suggestion from this parent, she put in calls to our Senators to ask that they push Congress to continue the subsidy.  One of the Senators would not have gotten her vote again, with the behavior of one of his Washington staffers in reply -- a reply that put my daughter in tears.  But then another staffer in the local office came through great . . . and said that a bill to continue the subsidy is in Congress.

    But the bill to continue the COBRA subsidy for those laid off in the last year is going nowhere right now, held up because of the (alleged) health care reform bill.  So get those calls and emails going to get Congress off its collective butt, if you really want to help those who are hurt the most by this economic mess.  Tell Congress to walk and chew gum at the same time.


    Held up, but not abandoned? (5.00 / 1) (#57)
    by EL seattle on Mon Nov 23, 2009 at 12:21:31 PM EST
    LINK to story about the  Brown/Casey COBRA Subsidy Extension and Enhancement Act (Nov. 6).

    I'm still wondering how many people have been able to take part in this subsidy program, though.  A subsidy to set the cost at 35% is a good support level, but for many of the unemployed, it's still unaffordable.  I wonder how many can't affort even that?


    Reducing cost by two-thirds (none / 0) (#61)
    by Cream City on Mon Nov 23, 2009 at 01:08:24 PM EST
    is huge for several I know personally, in my family and others.  They are getting unemployment comp, too.  They all have serious health conditions.  Reducing the cost of health insurance from $500 a month, in one example, to $165 a month makes it affordable for that person -- admittedly while also having had to move back home. . . .  But that's a lot less for us to pay to keep coverage for that kid, too, with all the other costs now.

    In sum, yes, it is working for those I know who have to be on COBRA.  It is making it more affordable than other health insurance options.  

    How many there are across the country, I don't know -- but I do know that extra workers had to be hired to keep up with the demand here -- in one of the hardest-hit states.  And creating those jobs was a good thing as well.


    COBRA is only (5.00 / 1) (#14)
    by gyrfalcon on Mon Nov 23, 2009 at 09:27:44 AM EST
    a continuation of employer-provided insurance when you're laid off.  It's wildly, prohibitively expensive, and in any case doesn't apply to anyone who didn't have employer insurance in the first place.  It's a useful thing when you're "in between" jobs for a couple of months.  Otherwise, it's a very bad joke.  

    Yes. And that is why subsidies (5.00 / 1) (#18)
    by Cream City on Mon Nov 23, 2009 at 09:37:38 AM EST
    to make it affordable, at least for now, need to be continued.  Otherwise, COBRA is too expensive for the unemployed -- and so are other alternatives, especially for those with pre-existing conditions.

    (And I can attest, as well, that those pre-existing conditions also often are the cause of students having problems in college, dropping out of college, etc., complicated by the additional time and worry about getting coverage of those costs.)


    Agreed entirely (none / 0) (#29)
    by gyrfalcon on Mon Nov 23, 2009 at 09:53:42 AM EST
    Every little bit helps some.

    But the OP seemed to think COBRA was something much broader than it is and I was just trying to set him/her straight-- before you all beat me to it. :-)


    Forget 'victory', 'posturing' and 'positioning' (5.00 / 1) (#4)
    by kidneystones on Mon Nov 23, 2009 at 08:30:10 AM EST
    I just read the polling numbers over at TPM and at some point Dems might just want to think about improving the lives of ordinary folks and can the whole victory dance routine. Didn't work for me when Bush did it and I'm sure the preening is wearing extremely thin with just about everyone, as is blaming others for the fact Dems can't seem to produce jobs or reduce deficits.

    Modest, real, improvements are far more likely to win voters over than 'historic' legislation. The real danger is that Dems really don't have workable solutions to real problems. It's hard to imagine any Afghanistan solution looking much different than more of the same plus or minus tens of thousands of troops, which is going to make a lot of folks wonder why it took so long to do pretty much what everyone figured he'd do.

    Dems will be fine if they can keep things from tipping right over. Time to stop digging. Stimulus I didn't work. Doubling down and adding more debt might just kill off any hopes Dems have of staying alive in 2010. Making sure folks have food and a few presents for their kids this Christmas might be the best anyone can expect.

    If the Republicans were in charge Springsteen and Seeger would be singing in front of soup kitchens.

    Some see the fact they're not yet as a blessing.

    I'm not so sure.

    Is there anything in the way Dems have (5.00 / 2) (#5)
    by Anne on Mon Nov 23, 2009 at 08:38:10 AM EST
    handled the health care/health insurance/reform effort that would lead anyone to believe they have what it takes to salvage anything meaningful from this legislation?

    I mean, seriously.

    Even if, let's say, there was a decision to take the pitiful public option off the table, is there any reason to think Republicans and conservative Dems would not attack what's left, and in response, the so-called leadership would not once again bend over to accommodate them in the interest of passing something, anything, that would let Obama off the hook?

    Yes, we should definitely expand assistance, and increase Medicaid funding, and we need the reforms to insurance that are preventing people from being able to afford the care they need, but helping poor people is not a popular thing among Republicans and conservative Democrats - and they will scream bloody murder about the cost and about how that cost will be paid for.

    They will stick with a/the public option for no other reason than to be able to claim that there is one, even if it has been so gutted and weakened as to be nearly meaningless, and even if it will be further marginalized by poorly thought out opt-out provisions.  They will keep the individual mandate that helps no one but insurance companies, and will be shocked - shocked! - when those same companies immediately identify all the loopholes and work-arounds and get right back to doing the things that got us here in the first place; there will be more shock, and even some outrage and for sure some hearings, when record profits are announced by the health industry companies.

    If ever there was an example of fiddling while Rome burns...

    Give it up (5.00 / 3) (#6)
    by kmblue on Mon Nov 23, 2009 at 08:38:17 AM EST
    Too little too late.
    I'm sorry, I just don't care anymore.
    Time to see clearly that our Emperor has no clothes.  

    I wish (5.00 / 5) (#8)
    by ruffian on Mon Nov 23, 2009 at 08:42:42 AM EST
    they would have started with that approach from the beginning instead of calling such insurance assistance and regulation 'reform'. Few would have faulted Dems for attempting modest but positive changes thus year, when there is so much else in the table.

    The real trick is of course to make sure whatever does get passed is effective. I tend to think the insurance companies will find their way around the new regulations. On my optimistic days I think there will be a huge clamor for single payer in a couple of years, and the pols that can ride the ' we tried it your way and it didn't work' wave will do very well. In the meantime though, more people will fall through the cracks.  

    In ten years we will be talking about (5.00 / 1) (#17)
    by inclusiveheart on Mon Nov 23, 2009 at 09:34:26 AM EST
    how many people are paying penalties for not being able to affort mandated healthcare at the unchecked rates the private insurers will charge.  I guess the upside will be that then we will have a firm fixed estimate of how many people are going without insurance and healthcare at that point.  At that point, we won't have to estimate the number of people who are locked out of our expensive healthcare system.

    The challenge then will be figuring out a way to stop the government from taxing the "have nots" in order to support the health benefits of the "haves".  It is surreal really.  To think that this country could fall to this point - that that it is even remotely possible that the Congress and this President would sell a portion of the population to the private insurers as in effect indentured servants - is quite breath taking really.

    More frightening still is the fact that while the Republicans will run against this great injustice and likely win as a result, they will never roll it back because this is a goal they've been striving towards for years.  What industry is next?  Which industry will get their pound of flesh out of us next?  Will we each be penalized for not having a minimum amount of money in a bank account as a way of keeping the banks flush with cash?  


    As far as I can tell, the penalties are fairly low (none / 0) (#19)
    by andgarden on Mon Nov 23, 2009 at 09:37:50 AM EST
    The problem is that paying a penalty doesn't get you healthcare. That could have been addressed by automatic enrollment into the public plan. . .

    Can you tell if the penalties (none / 0) (#21)
    by Cream City on Mon Nov 23, 2009 at 09:41:32 AM EST
    are waived for the unemployed?  I don't find that in anything I've read.  And it would seem obvious.

    Subsidies from the government (5.00 / 2) (#28)
    by inclusiveheart on Mon Nov 23, 2009 at 09:53:11 AM EST
    kick in at a certain point, but for a moment step back and think about the middle class and working class families that are already struggling to make ends meet and then consider the cost of average health insurance premiums which continue to rise - and it isn't hard to imagine a lot of people having to opt for a $1500 annual penalty instead of having to come up with $15,000 annually for coverage.  The gap between the two numbers is just too large (and expected to get larger) for most people to make up and the prospects for American growth and economic stability too low at the moment to imagine that people will simply fall out of the insured category as a way of keeping the roof over their head and food on the table.

    I'm not sure how that answers (none / 0) (#46)
    by Cream City on Mon Nov 23, 2009 at 10:30:35 AM EST
    my question.

    I am pretty sure that they are means tested (none / 0) (#23)
    by andgarden on Mon Nov 23, 2009 at 09:50:02 AM EST
    But it's hard to tell exactly what's in which bill.

    Wonder whether or not the (none / 0) (#26)
    by MO Blue on Mon Nov 23, 2009 at 09:51:22 AM EST
    long term unemployed are eligible for subsidies.

    Why wouldn't they be? (none / 0) (#32)
    by gyrfalcon on Mon Nov 23, 2009 at 09:57:07 AM EST
    The current proposal leaves (none / 0) (#38)
    by MO Blue on Mon Nov 23, 2009 at 10:16:42 AM EST
    12 million or more eligible Americans uninsured. Have not heard who fits into the group that will not receive coverage.

    The status quo leaves 46 million (5.00 / 2) (#40)
    by Big Tent Democrat on Mon Nov 23, 2009 at 10:23:01 AM EST

    A health insurance assistance bill would cut the number by 34 million, by your math.

    That is worth doing, if done in a way that future efforts at reform are not stymied.

    That is the point of my post.


    And we're still assuming that (5.00 / 3) (#49)
    by Anne on Mon Nov 23, 2009 at 10:54:17 AM EST
    having insurance means having access to affordable care - something I'm not at all convinced is a credible assumption.

    Insurance is not a magic wand, and I fear that we have allowed the emphasis to shift away from CARE to insurance - they are not the same thing.

    I am for people being able to afford to see the doctor, to get the treatments they need, to get the medications that will make them well; insurance that shows no signs of becoming more affordable over time is not likely to make that a reality for a lot of people.


    My reading comprehension skills are (5.00 / 2) (#52)
    by MO Blue on Mon Nov 23, 2009 at 11:01:18 AM EST
    developed enough to understand the point of your post. Simple math is also part of my skill base. The fact that I question how a current aspect works does not denote disagreement with what you have written.

    I would support just subsidizing people who are without health care provided it actually gave them access to affordable care. The question is not only what is not contained in the current proposal (i.e. public option) but what will be contained in the final draft that would jeopardize not only future efforts at reform but short and long term affordability of health care for everyone. The Senate Finance bill had a mechanism that reduced the subsidies if needed in order to make it deficit neutral. In fact, the CBO estimated that it might be necessary to cut subsidies by 15% in 2015 and 2016 to meet this requirement. That is just one possible provision that could make health care too expensive for even those receiving subsidies.


    Pelosi bill (none / 0) (#68)
    by Socraticsilence on Mon Nov 23, 2009 at 11:53:30 PM EST
    is linked to income- 2.5% off taxable income, Baucaus and Reid each have bills  that phase in a $750 charge.

    $1500 is a lot of money (none / 0) (#22)
    by inclusiveheart on Mon Nov 23, 2009 at 09:47:14 AM EST
    to some people - and yes that's the whole point - that people who can't afford the private insurers' going rates will pay and get nothing in return - of course other people benefit from their penalty monies because the point of taking the penalty is to prop up the private insurance model for healthcare.

    I honestly don't understand why more people don't get how completely screwed up this mandate plan is on so many levels.  Even with the public option in its current form it is an injustice.


    I think it's only half that, yearly (none / 0) (#24)
    by andgarden on Mon Nov 23, 2009 at 09:50:26 AM EST
    Okay so half that. (none / 0) (#33)
    by inclusiveheart on Mon Nov 23, 2009 at 09:58:30 AM EST
    Regardless, it is a lot less than maintaining private health insurance and the pressure on the average American family to earn enough just to stay in their homes and to buy food at this point is pretty intense.  Since there are no caps on private insurers' rates and no real public option for those who will be squeezed in the middle and working classes, this mandate idea is a recipe for disaster.  At least at the proverbial company store people got a little bit of food in return for their wages - a little - but it was better than nothing at all.

    Oh come on inclusiveheart (none / 0) (#35)
    by andgarden on Mon Nov 23, 2009 at 10:01:25 AM EST
    You aren't guaranteed a service for every tax dollar you have to pay. The policy is no ideal, but this won't be the first or most significant tax with an arguably regressive effect.

    My tax dollars and yours aren't supposed (5.00 / 2) (#41)
    by inclusiveheart on Mon Nov 23, 2009 at 10:23:56 AM EST
    to end up subsidizing share holder profits in private companies without payback to our government.

    And I don't understand how anyone can think that it is a good idea to make a working class person subsidize the likes of Donald Trump's health plan - very affordable to him - not so much the rest of us.  This plan is currently upside down.


    And no, if we keep private insurance as the (none / 0) (#27)
    by andgarden on Mon Nov 23, 2009 at 09:51:59 AM EST
    primary means of delivery, the mandate is essential policy. The only problem arises when there is no way to ensure that the private insurers provide a worthwhile product. That's the purpose of the public option.

    I don't think you understand how limited (none / 0) (#36)
    by inclusiveheart on Mon Nov 23, 2009 at 10:04:10 AM EST
    the Senate's pubic option is.  Only about 6 million people would qualify to take advantage of it.

    After all the fuss, public health plan covers few

    WASHINGTON - What's all the fuss about? After all the noise over Democrats' push for a government insurance plan to compete with private carriers, coverage numbers are finally in: Two percent.

    Nonsense (5.00 / 1) (#37)
    by andgarden on Mon Nov 23, 2009 at 10:05:20 AM EST
    I do understand how limited it is. but unlike you and Ezra Klein, I think there is a difference between having one and not having one.

    Don't confuse me with Ezra Klein. (5.00 / 1) (#44)
    by inclusiveheart on Mon Nov 23, 2009 at 10:28:40 AM EST
    I am discussing the liabilities of mandates, not arguing against the public option.  I think the public option is critical to anything that might be called reform, but I do not think that the mandates and penalties are at all reasonable or fair as the bill is currently structured.  Because most people will not qualify for the public option - which means that most people will be forced to purchase uncapped premiums to private insurers or go without and pay penalties for which they will get nothing.

    Due respect (5.00 / 1) (#55)
    by Big Tent Democrat on Mon Nov 23, 2009 at 12:08:37 PM EST
    you sounded like Ezra Klein in that comment.

    If you reject the potential of the public option, that's fine. But do not play dumb on that point. Just state your view.

    Everyone knows how limited it is. At least at Talk Left. the idea is that it can grow.


    Also, I fundamentally disagree with (5.00 / 2) (#60)
    by inclusiveheart on Mon Nov 23, 2009 at 12:41:08 PM EST
    angarten's statement that if we are to stick with the private system that mandates are a must.  If we are to stick with a an unchecked private system, then mandates shouldn't even be up for discussion.  If we are to shift to a public system, then mandates become acceptible.  But this notion that if we allow private insurers to run the show, then we should not be forced to participate.

    I've consistently said that aside from single payer, I've never understood why Congress didn't sit down and figure out what they could offer in a public plan for $50-$100 a month and just create a public option that might serve as a baseline basic insurance coverage package.  If nothing else, they would have created a much needed floor that would arguably do more to help this situation - and might even help the private insurers by relieving them of the burden of providing that basic care and allowing them to sell more expensive exotic plans where their currently unworkable business model be changed enough to actually allow them to make money and deliver on services they've promised.


    My thing would be (none / 0) (#65)
    by Salo on Mon Nov 23, 2009 at 03:02:19 PM EST
    having unions shift their cash over to a publicly administered system.  

    It was not my intention to come across (none / 0) (#58)
    by inclusiveheart on Mon Nov 23, 2009 at 12:24:22 PM EST
    as an opponent of the public option.  I am looking this thing as a whole and thinking about all of the moving parts - not just one.  I think the mandates should be thrown out even if the public option stays in - because of two things whic are:

    1. The private insurers premiums are completely undregulated; and
    2. in its current form, the public option, it is too limited in qualfying applicants to justfy forcing everyone to buy into the system.

    I do not reject its potential by the way.  I reject the hype surrounding the public option in its current form - I reject the notion that it justifies penalties being that as an alternative almost it is pratically inaccessible to most Americans - which is vastly different from not understanding or believing in the potential for the public option to be better.  If those penalties offered even the tiniest bit of access and coverage to healthcare, then I'd be able to support mandates and penalties, but as it stands now I am opposed to them.

    It won't be just a couple of years (none / 0) (#15)
    by gyrfalcon on Mon Nov 23, 2009 at 09:30:30 AM EST
    more like a decade or so, but otherwise I agree with you entirely.

    Yea, 10 years is what (none / 0) (#70)
    by ruffian on Tue Nov 24, 2009 at 06:34:03 AM EST
    I think on my realistic days.

    I do know it must be hard for those public option supporters among the pols that realize that too to argue for it by reassuring their colleagues it is not the first to a government takeover, all the while knowing it must be. In a way the Republicans and others who fear that are exactly right. Although they won't put it in those terms, they know the current system can't hold in the long term.


    Just my opinion (5.00 / 4) (#47)
    by Militarytracy on Mon Nov 23, 2009 at 10:33:43 AM EST
    but anyone passing mandates in this economy without a public option is completely nuts and has a political death wish.  The only thing that could possibly save anyone is if we can revisit the healthcare insanity that currently grips this country in six months, after people have suffered even more and it is do or die for pols.  I do hate to think about those who are going to suffer though, maybe even die due to this heinous joke of a Congress.  But of course anyone dying due to this crap will have not pulled hard enough on their own bootstraps.  Outside of these thoughts count me as speechless at how degraded humanity in America has become.  Animals have more activists fighting for them to be treated humanely than human beings do.  Isn't that supposedly one of the traits of sociopaths.....indifference to their own kind and over identification with animals?

    Like oculus says (5.00 / 1) (#62)
    by Pacific John on Mon Nov 23, 2009 at 02:05:33 PM EST
    intentionally hurting animals is a very bad indicator, as is fire setting.

    Your point gets to something civil rights activists complained about, that in the '70s, white liberals quit fighting for economic and racial justice, and moved on to what civil rights activists saw as vanity movements with ephemeral goals, like anti-nuke, environmentalism, animal rights, and NOW, which was loudly criticized as being white, upper class and elitist.

    Liberal elitism isn't sociopathic, but it's not particularly self-aware.


    Didn't black liberals go into a crouch too? (none / 0) (#63)
    by Salo on Mon Nov 23, 2009 at 02:59:45 PM EST
    40-50 years of struggle and there's an African American centrist in the White House.  racial and economic justice parted ways decades ago.

    One of the symptoms of antisocial (none / 0) (#54)
    by oculus on Mon Nov 23, 2009 at 12:05:02 PM EST
    personality disorder is youthful abuse of animals, for example, setting animals on fire.  

    I cannot support the Medicaid expansion (none / 0) (#7)
    by me only on Mon Nov 23, 2009 at 08:40:03 AM EST
    TN is cutting TNCare because the state cannot afford it.  My Democratic governor opposes this plan.  States cannot print money like the federal government, nor can they run permanent deficits (CA looks to be trying though).

    Dump the whole bill.  Start with something smaller.  Put out a bill with a single payer option for children financed by the federal government.  Let the Republicans howl about how they don't support children.  (It is an option, anyone who wants to keep their insurance for their kids can.)  After that generation grows up they will support single payer more than not.  It will take time (I probably won't live to see it happen, but whatever.  All things worth doing are worth doing well and this "reform" is nothing better than insert gunny sgt highway's favorite descriptor here.)

    Perhaps (none / 0) (#13)
    by CoralGables on Mon Nov 23, 2009 at 09:25:46 AM EST
    the best way to expand a government sponsored health care program is to target a specific group of individuals as was done with medicare.

    Medicare for all is unlikely to catch on for another generation or more, and the elimination of the necessity for private health insurance companies which I see as the main step to constrain costs isn't happening anytime soon.

    The least politically daunting approach would be to offer free health care to all children 5 and under. As you noted, let's see them argue against health care for small children. No one can claim the moral high ground with that approach. Of course we are probably also looking at 2026 or so for this next step.


    Don't we have that already (5.00 / 1) (#31)
    by gyrfalcon on Mon Nov 23, 2009 at 09:55:21 AM EST
    with S-CHIP?  Isn't that what kdog is paying (or would pay if he bought them legally) gigantic cigarette taxes to fund?

    Nope (none / 0) (#39)
    by CoralGables on Mon Nov 23, 2009 at 10:16:45 AM EST
    that's a state by state program with fed support. I mean all children regardless of family income.

    SChip like every patch leaves holes in coverage and millions of kids with no coverage.


    Medicaid is a state by state program (none / 0) (#42)
    by Big Tent Democrat on Mon Nov 23, 2009 at 10:24:01 AM EST
    Indeed, it is an Opt In public Option that is means tested.

    Medicaid requirements vary by state (none / 0) (#50)
    by chancellor on Mon Nov 23, 2009 at 10:58:28 AM EST
    Actually, the requirements for being able to enroll in Medicaid vary from state to state. In Illinois, for example, assets--not just income--are used to determine whether or not you are eligible for Medicaid. So if you live in Illinois, it doesn't matter what your income level is, as long as you have $3000 worth of assets you don't qualify for any form of public assistance--including Medicaid.

    Consequently, whenever you say how great it is that the bills under consideration will increase Medicaid income eligibility, you need to remember that not all states have an income-only threshhold. Medicaid expansion is not the magic answer unless all states have the same Medicaid requirements.


    It's an absolute good. (none / 0) (#64)
    by Salo on Mon Nov 23, 2009 at 03:01:07 PM EST
    But it's really kind of pathetic.

    Quitting Isn't Really an Option (none / 0) (#9)
    by kidneystones on Mon Nov 23, 2009 at 08:48:44 AM EST
    I should have been more fullsome in my initial support of BTD's post. Cap and trade is a non-starter. The WH is already trying to figure out how to explain to voters how all America is going to get from all these trips abroad is a prize for 'occupant'.

    I have a lot of respect for all the folks who turned out to vote on both sides last year. The folks without jobs and the families struggling to keep their homes need representatives willing to fight for them. Those who don't will be replaced.

    That much, I think we can count on. Time to buck up.

    IIPPEAA (none / 0) (#56)
    by waldenpond on Mon Nov 23, 2009 at 12:10:29 PM EST
    I don't support subsidies to purchase a policy from the private insurance cartel.  I am willing to pony up money for a public option.  So now the Democrats should start celebrating the Insurance Industry Profit, Protection and 'Assistance' Act?  I'll contact my congress people but they are all the type to whine 'win' no matter the bill.

    When we get a real President? (none / 0) (#59)
    by pluege on Mon Nov 23, 2009 at 12:35:03 PM EST
    The other is to bargain for a health assistance bill that does not kill the chances for real reform down the road while helping the less well off in the short term.

    And when, and who might that be.

    When, can not happen until corporate media is neutered. As long as they manipulate the public information in favor of the plutocracy, reform in health care or anything else can not succeed.

    Who could be a number of candidates, but real progressives can not succeed as long as the corporate media is free to trash them personally, silence and distort their message, boost their opposition, and distract and dissemble with the media's lies, infotainment, and dissembling.

    Healthcare Reform (none / 0) (#69)
    by Socraticsilence on Mon Nov 23, 2009 at 11:55:35 PM EST
    Took down Clinton and LBJ- what do you want FDR to come back and pass it.