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Selling The Sell Out On HCR

By Big Tent Democrat, Section Obama Administration
Posted on Mon Dec 14, 2009 at 09:49:39 AM EST
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TPMDC:

The drumbeat started early in the process - no matter what the final health care bill looks like when it reaches President Obama's desk, it will do more for Americans than ever before. [. . .] Leadership and the White House want a bill, and the message machine will be cranking up into high gear to push the historic nature of the legislation's basics.

White House Press Secretary Robert Gibbs [. . .] - and Peter Orszag, and Nancy-Ann DeParle, and on - tell reporters and voters to "keep in mind" that once the legislation is passed more than 30 million people who never had health care will have it [. . .]

What they DO NOT say - that the 30 million people getting insurance do not get it because of the Mandate, or the Exchange, or the Excise Tax. What they do not seem to get is that they will NEVER get 60 votes in the Senate for their "health care reform." Strip down the bill for reconciliation and we can insure 30 million Americans. Stick to selling the capitulation - and Obama and his Village Blogger pom pom waving cheerleaders will end up with nothing.

Speaking for me only

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    Selling The Sell Out On HCR | 48 comments (48 topical)

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    Then if the only thing that matters (5.00 / 1) (#2)
    by MO Blue on Mon Dec 14, 2009 at 10:20:10 AM EST
    is that Obama gets something, no matter how bad, to sign, the obvious solution is just to task Lieberman, Snowe, Nelson and Lincoln to draft the final legislation.

    Will it be horrible legislation that benefits no one but the insurance and pharmaceutical industry? Will it eventually make the Democrats a minority party for decades? Sure, but Obama will be able to put a check mark behind "Did health care" and for a few years some people will get subsidies.

    The HRC jello every one liked in HCR (1.00 / 1) (#9)
    by Politalkix on Mon Dec 14, 2009 at 11:03:26 AM EST
    I would like a strong HCR bill like anyone else but the "acting up" that some people are doing now after swallowing the Hillary jello on HCR is really amusing to watch.

    Parent
    Are the primaries ever over for you? (5.00 / 4) (#11)
    by Militarytracy on Mon Dec 14, 2009 at 11:08:25 AM EST
    Can you ever get past your last best win to living in the here and now and the accountability of those who are now in charge?  Jesus Christ you give me a headache.  Is the best you can do really only being last year's winning Obot?

    Parent
    I was just adding to the pot (1.00 / 1) (#16)
    by Politalkix on Mon Dec 14, 2009 at 11:25:25 AM EST
    that BTD has been stirring with the help of all of you.
    Look MT, you could all have discussed in a constructive way how to improve the HCR bill without constantly trying to stir the primary pot. But when the pot gets stirred, should it really bother you if a very small minority throws in a couple of ingredients?

    Parent
    the problem (5.00 / 1) (#20)
    by hookfan on Mon Dec 14, 2009 at 11:34:12 AM EST
    is the only ingredient you through in is a red herring, and a really ripe one at that.

    Parent
    People are upset about the primaries (5.00 / 1) (#22)
    by Militarytracy on Mon Dec 14, 2009 at 11:43:44 AM EST
    because there was a lot of railroading and not much earning.  This whole cheering for the personality thing is what gets us to these places where we get people in office who don't owe any voter anything. The blogosphere is learning a very important lesson right now about championing rockstarism over results.  Let's learn it, why don't we?  There were many unfair happenings during the primaries but wow did I see a whole bunch of bloggers throw every principle they had in the toilet attempting to get their barbie doll the nomination.  Because all they did was spew idiot speak, so many only managed to literally make themselves voiceless.  Sad isn't it?  I was more of an Edwards supporter.  Imagine what would have happened if my idiot would have gotten the nomination......and I believed in what he stood for and he does have a track record on geniunely caring about and applying himself to issues that matter most to me.  It would have been a bad scene though if he had gotten the nomination and he was willing to put my country's safety and sanity at risk for his ambition.  I can admit stuff though.  Can you?  Are you ever going to be willing to demand actions and results over your desire to see pink ponies?

    Parent
    You should stick to adding real ingredients then (5.00 / 3) (#25)
    by cawaltz on Mon Dec 14, 2009 at 11:51:44 AM EST
    not made up ingredients like fairy wings or pixie dust.

    We have no way of knowing how Hillary would govern as President. The idea that she would have been no different is a figment of imagination for those of you still interested in excuse making.,

    Parent

    I didn't think she was vague at all (5.00 / 2) (#12)
    by cawaltz on Mon Dec 14, 2009 at 11:11:30 AM EST
    She didn't have an enforcement mechanism but other than that I think she was pretty clear that she wanted a plan that insured everyone.

    As for Obama he's all over the board, as usual. He didn't like mandates, now he loves them. Ironic, considering the big stink he made about them during the primaries.

    Parent

    Mandates are necessary (none / 0) (#30)
    by Socraticsilence on Mon Dec 14, 2009 at 12:39:39 PM EST
    but would require a complete overhaul to work-- even if you're going to require gauranteed issuance, (which along with mandates removes adverse selection from the equation) things like Medicare essentially enhance the profits of the Insurance industry by giving them a risk pool that consists of the young to middle aged, and the lower middle to upper class-- any public option would be impossible to sustain in the long run due to the self-selection of its risk pool-- it would consist almost entirely of the poor and/or the chronically unemployed. The answer of course would be a public option which auto-enrolls those without coverage and is paid for by payroll deduction, perhaps more sellable by going the German route and having regional options rather than a single national plan ala Canada (note of course that these systems all work because they're funded by massively shared risk pools- Canada including all citizens, Germany all but the top 7%).

    Parent
    The system needs an overhaul (5.00 / 1) (#37)
    by cawaltz on Mon Dec 14, 2009 at 01:07:04 PM EST
    I wouldn't be adverse to a mandate if I thought it would remove problems like medical bankruptcies from the equation. What's being floated doesn't though. Frankly they seem to have concentrated MORE on how to enforce a mandate then they did on how to ensure the average American could afford medical care should a medical emergency arrived. I find that problematic.

    Parent
    Oh I'm down with a complete overhaul (none / 0) (#39)
    by Socraticsilence on Mon Dec 14, 2009 at 01:21:59 PM EST
    I just don't see how its possible, its funny when i signed up for this Class in the Fall I thought I'd gain incredible insights and have at the very least a workable solution or maybe some health-- not so much-- I'm more depressed than ever and after reading the actual language of every major healthcare reform proposal I actually support the Baucus approach (essentially its Mass care but with support for states to form non-profit insurance options which would hopefully solve the massive cost issues the Bay state faced).  If you read the history of Healthcare Reform in America its hard not to get depressed-- especially in light of the growth of the Health Insurance industry-- the only answer I can think of is bringing the Head of the AMA in 1945 to the world of today and showing him what opposing Health Care reform will result in-- basically after Doctors lose control to Health Insurance execs there overall position becomes worse especially in regards to things like patient selection and malpractice.

    Parent
    I am beginning to doubt you have the capability to (5.00 / 1) (#14)
    by MO Blue on Mon Dec 14, 2009 at 11:16:59 AM EST
    discuss any of the administration's current policies without bringing Hillary into the equation. Pure distraction tactics to avoid discussing an issue IMO.

    Parent
    bizarre...and which flavor of Obama Koolaide (5.00 / 2) (#17)
    by kempis on Mon Dec 14, 2009 at 11:26:40 AM EST
    was laced with whatever makes you so besotted still that you're unable to see the irony in whipping out an article that chronicles how Obama attacked Hillary for mandates--when he himself agreed to them once in office?

    Parent
    Mandates are a product of the reconciliation (2.00 / 1) (#21)
    by Politalkix on Mon Dec 14, 2009 at 11:41:43 AM EST
    process that happened with Hillary after the primaries got over. I think Obama should just go back to what he promised during the primaries. Just provide subsidies so that a large % of people who did not have coverage got some coverage and leave it at that. Trying to adopt a part of HRC's health care plan is turning out to be a nightmare. It is not making people like me happy and I can see that it is making HRC's most vocal supporters very unhappy.
     

    Parent
    You do realize (5.00 / 6) (#24)
    by cawaltz on Mon Dec 14, 2009 at 11:47:27 AM EST
    that Hillary is SoS and Hillary has nothing to do with the mess being made right now on this particular domestic policy.(Or are you going to be able to prove that she was part of some hooky made up reconciliation process on Health care) The only one Obama reconciled THIS particular atrocity with is the insurance industries who wanted it.

    Parent
    Fantasy (5.00 / 3) (#28)
    by hookfan on Mon Dec 14, 2009 at 12:07:06 PM EST
    but wouldn't it be nice if the obama administration would actually fight to implement what he said he was going to do in the general election? There was no "I'm going to bail out the bankers at taxpayers expense, with no strings attached". There was no "I'm going to continue, maybe even expand Bush's doctrine of state's secrets". There was no "I'll get to dealing with unemployment and job creation in my own sweet time, if there is any money left over after the giveaway to the financial industry." There was no "I'm going to let homeowners go bankrupt and provide at best minimal support to deal with your needs to save your home". There was no "I'm going to  pursue the same things that John McCain wants in taxing your insurance benefits." There was no "I'll pass any insurance reform bill that won't negatively impact the insurance industry's bottom line and make behind the door deals that protect pharmaceutical industry's profits, and protect their bottom line even though it will cost you." etc., and etc.,. . .

    Parent
    Subsidies (5.00 / 1) (#31)
    by Socraticsilence on Mon Dec 14, 2009 at 12:46:33 PM EST
    would be a piecemeal solution, but is probably far more usable-- the mandate while a crucial aspect in any comprehensive solution is only applicable if we're willing to apply something that the US currently has no stomach for-- egalitarian coverage- people all get roughly the same coverage regardless of payin- that's what makes the funding mechanisms in mandate countries work-- look at Germany, Japan, France or Switzerland-- they all have multiple non-profit plans, they all use a mandate but said mandate is almost always applied to the employer (in Japan its sometimes applied to the individual-- when you don't pay you can't use your coverage until all past premiums are paid-- which should logically lead to a massive adverse selection problem but considering the relatively low unemployment and the prevalence of large corporate plans in the end it makes this less of a problem than it would be).

    Parent
    I could see egalitarian coverage (5.00 / 1) (#34)
    by cawaltz on Mon Dec 14, 2009 at 12:58:05 PM EST
    with allowance for people to purchase a secondary policy from the for profits for additional coverage. What I don't see is how mandating coverage and then allowing for caps on coverage helps the average American. Frankly, there has been little to no talk about what works and doesn't work in other countries. Instead we are supposed to be getting a "uniquely American" system. With "uniquely American" being a euphemism for "system where taxpayer gets screwed."

    Parent
    This is what is used (none / 0) (#40)
    by Socraticsilence on Mon Dec 14, 2009 at 01:34:04 PM EST
    in Canada (which I don't want- their system is far, far less desirable now that I've looked at it-- if necessary i can elaborate), Britain, Germany and France-- Supplemental Health insurance is an option which while not great in terms of economics (the impact of adverse selection is almost inescapable here- thus coverage is usually either really expensive, or it provides primarily luxury services-- think about it-- say supplemental insurance provided increased Cancer coverage (greater options more longterm care)-- the vast majority of people who would purchase it would be those with an increased risk of the disease making the risk pooling which enables insurance companies to remain solvent much less to profit a much dicier proposition) its possible it could be sold to some companines. The problem is that basic care to 2/3s of Americans is currently provided by Private health insurance obtained through employment(not sure what total percentage is including individual purchase) the vast majority of that through for-profit companies-- basically you'd be calling for a near literal reverse decimation of their profit margins.  

    Parent
    not really (none / 0) (#3)
    by CST on Mon Dec 14, 2009 at 10:32:54 AM EST
    I don't see how that bill passes the house.

    Parent
    Really? (5.00 / 3) (#4)
    by cawaltz on Mon Dec 14, 2009 at 10:38:58 AM EST
    I figure if the Stupak amendment can pass the House then I'm pretty certain any other POS legislation has as likely a chance of passing. Then again I get the impression Nancy wants her checkmark before 2010.

    Parent
    It barely passed the house as is (5.00 / 1) (#8)
    by CST on Mon Dec 14, 2009 at 10:53:51 AM EST
    and considering the number of reps who have felt a backlash at home, and since said they wouldn't vote for Stupak in a final bill... I'd say yea, they are gonna have a really hard time (IMO impossible) passing a Lieberman-worthy bill.

    Honestly, I am skeptical that a Lieberman-worthy bill will have 60 votes in the Senate.  Bernie Sanders anyone?  Maybe they get Snowe, but frankly I wouldn't be surprised if one of the blue-dogs backed out of even one of those bills - or another more liberal senator.

    Parent

    Here's to hoping (5.00 / 3) (#13)
    by cawaltz on Mon Dec 14, 2009 at 11:14:40 AM EST
    I think the whole thing should tank and they should start over from scratch. Maybe even let some of the single payer folk sit at the big people table and let expanding Medicare be scored by the CBO. Then again, Aetna and Cigna haven't fattened my wallet so that may be why I feel that way.

    Parent
    Maybe will have healthcare in another 20 years (none / 0) (#29)
    by Socraticsilence on Mon Dec 14, 2009 at 12:31:49 PM EST
    Its depressing if you read the history of Healthcare Reform proposals how often they've either failed and/or be watered down to the point of nothingness-- It was reasonably bad post-1965 it gets even worse after the passage of Medicare and Medicaid-- in the early 1970s both Ted Kennedy and Richard Nixon craft comprehensive national care proposals with universal coverage goals- they're both watered down and/or defeated (in large part due to a confluence of outside events, something that will be repeated again and again with eery regularity), in 1980 Carter gives universal coverage a shot and fails, in 1986 Congress attempts to create long-term/catastrophic coverage in Medicare this attempt is so effectively co-opted by the Insurance industry that the end product despite adding prescription drug coverage to medicare is co-opted due to dissatisfaction by seniors. In 1991- the race to fill the seat of PA. Sen. John Heinz turns on the promise of reforming Health Insurance-- leading the Clinton Campaign to adopt it as a national issue- unfortunately by the time the Admin. introduces it they've effectively alienated one of their most important interest groups, Unions (as well as the group which led the most successful reform- the 1965 M/M estab.)-- by pushing through NAFTA (which I agree with not arguing it here) thus the "army of foot soldiers" the administration was promised never materializes. (the story of industry capture is repeated with the 2003 MMA, the 1997 and 2009 SCHIP establishment and expansions had the support of the AMA and didn't encounter significant interest group opposition).

    Parent
    The selling point will be (5.00 / 2) (#5)
    by MO Blue on Mon Dec 14, 2009 at 10:41:41 AM EST
    it will save lives.

    Parent
    Yep (5.00 / 1) (#10)
    by cawaltz on Mon Dec 14, 2009 at 11:04:23 AM EST
    Any POS legislation is better than nothing seems to be the philosophy. As long as they can say ,"We did something" they can always lay claim to the ever popular, "Who could have imagined" and "I had no idea when I voted for it" later on down the line when people discover it's manure.

    I honestly think the underlying philosophy is the You can fool some of the people all of the time, and some of the people some of the time, and that will be good enough to get you re elected.

    Parent

    It has taken the House only a day (none / 0) (#48)
    by MO Blue on Tue Dec 15, 2009 at 01:29:37 PM EST
    to cave.

    Hoyer: House Will Accept Public Option-Free Bill

    Parent

    That's what happenned (none / 0) (#15)
    by dk on Mon Dec 14, 2009 at 11:23:03 AM EST
    in the stimulus bill.  I would just assume the same thing will happen here as well.

    Parent
    no (none / 0) (#19)
    by CST on Mon Dec 14, 2009 at 11:33:31 AM EST
    the stimulus bill, while it wasn't "big enough" it did go where it was needed, and it wasn't a sell out to any major corporations.  The problem with the Stimulus bill is that there wasn't more of it.

    I don't see how that relates in any way to what's going on here.  There is no "big pharma" in the Stimulus bill.

    Parent

    Yes. (none / 0) (#23)
    by dk on Mon Dec 14, 2009 at 11:46:01 AM EST
    What got into the Stimulus was what Snowe and Nelson wanted to go into the stimulus.

    Parent
    The fact that they voted for it (none / 0) (#27)
    by CST on Mon Dec 14, 2009 at 11:59:22 AM EST
    doesn't mean it's the same thing.

    It was not a "horrible bill that benifitted no one" which is the key quote from above.  A lot of people benefitted from the Stimulus bill.

    The biggest difference to me is that people might actually come off worse after this bill is passed, and it is a tax payer give-away to Pharma.  I don't see how you can possibly make the case that anyone was hurt by the Stimulus bill, or even that it was a give-away to a corporate industry.

    Parent

    So let me get this straight (5.00 / 3) (#6)
    by ruffian on Mon Dec 14, 2009 at 10:42:23 AM EST
    Congress has to pass something so Obama can say he did something. When if Obama had really done something - come up with a clear plan from the beginning and used his popularity and mandate to bring Congress along, maybe we would actually have a decent bill that everyone would be happy to take credit for.

    Instead they are reduced to selling a sellout. What a horrible waste.

    His primary expectation was clear: (none / 0) (#45)
    by Inspector Gadget on Mon Dec 14, 2009 at 02:21:43 PM EST
    Get something passed, and make sure it has ONE Republican vote so it is bi-partisan...don't give a darn what is in it, just who votes FOR it.


    Parent
    Actually I may end up with worse than (5.00 / 1) (#7)
    by Militarytracy on Mon Dec 14, 2009 at 10:51:01 AM EST
    nothing if Tricare gets to cap our yearly coverage.

    I've been meaning to ask (5.00 / 2) (#32)
    by Socraticsilence on Mon Dec 14, 2009 at 12:49:10 PM EST
    (I'm finishing a Health Care reform term paper) is Tri-care a possible national healthcare model or is it to highly subsidized by the government at large to be used by everyone? (I realize it would entail a massive expansion of government healthcare provider employment-- I'm hoping the cost savings this provides offsets the robustness of the plan).

    Parent
    The DoD has been complaining about it (5.00 / 1) (#36)
    by cawaltz on Mon Dec 14, 2009 at 01:04:03 PM EST
    for years. It's almost entirely government subsidized. I imagine placing caps on coverage is like a dream come true for the bast- er I mean bean counters.

    http://www.cqpolitics.com/wmspage.cfm?parm1=5&docID=news-000003098130

    For the record, I worked in a military pharmacy. We almost always ran out of money in September. It was sad to be handing out IOUs for stuff like Cyclosporine or insulin.

    Parent

    While Caps (5.00 / 1) (#43)
    by Socraticsilence on Mon Dec 14, 2009 at 01:41:02 PM EST
    are lame- I guess it just underscores why Tri-star isn't universally applicable barring a substantial re-working in the national tax structure.

    Parent
    Interesting story about Tricare (none / 0) (#47)
    by beowulf on Mon Dec 14, 2009 at 04:03:17 PM EST
    Tricare is "single payer" plan that the government  farms out  the management into three regional contracts (Humana, for example has the Southern region contract).  An improvement over, say, FEHB, because  the insurance companies get their contracts by competitive bid, not by marketing to consumers.  What's more, Tricare matches Medicare's low provider rates and (IIRC) the VA's low drug prices (Tracy, please jump in and correct me if I get any of these details wrong).

    For active duty personnel and their families there aren't any premiums.  As a consequence,  after Congress allowed reservists to buy into Tricare in 2005, the Pentagon wasn't sure how to set premiums for this new Tricare Reserve Select (TRS) plan.   They went to the FEHB, and priced out a comparable policy for federal employees, adjusted the rate down the individual rate by 32% (and the family rate by 8%) to adjust for the younger (and healthier) demographic.

    After a year of TRS operations , the Pentagon reported something interesting.

    The premium for individual coverage under tier 1 was 72 percent higher than the average cost per plan of providing benefits through the program. Similarly, the premium for family coverage under tier 1 was 45 percent higher than the average cost per plan of providing benefits.
    http://www.gao.gov/htext/d08104.html

    So naturally, the "Team of Ten" senators looked to the more expensive  FEHB as the public option model instead of the more affordable Tricare Reserve Select program.  

    Parent

    It is subsidized by the government (none / 0) (#35)
    by Militarytracy on Mon Dec 14, 2009 at 01:01:10 PM EST
    but that part of it is very hush hush.  Good luck coming up with any figures on that.  We have had certain situations arise though where we have had to employ a patient advocate's help......and they are provided by the military and have an office in the healthcare facilities.  What happens is if the insurance companies underwriting Tricare deny you something, you go speak to a patient advocate and then somehow things get worked out.  Only recently did I discover that the "working out" is where the government picks up the tab for what the insurance companies underwriting are denying to pay for.....Ta Da....you have full coverage insurance that taxpayers pay a pretty penny to insurance companies for and then when the insurance company isn't making enough profit the taxpayers pay for the patients medical bills out of pocket anyhow. Hopefully this extremely overpriced system paying middlemen through the nose for nothing all leaves a family stress free enough that you can send one of the family members away overseas and place their life in extreme danger.

    Parent
    Yeah that's what I figured (none / 0) (#41)
    by Socraticsilence on Mon Dec 14, 2009 at 01:36:10 PM EST
    I've tried to find a hard figure for the federal matching rate for just the civilian employee benefit system and its not easy to find. The militarized version is going to be much harder to see.

    Parent
    My bad (none / 0) (#42)
    by Socraticsilence on Mon Dec 14, 2009 at 01:39:26 PM EST
    sorry, I'm tired I just called up my paper again and the FEHB matching rate is 65%-- which is both much higher than the normal employer match rate and is applied to plans negotiated by a massive market sharer.

    Parent
    Even Booman wants reconciliation now (none / 0) (#1)
    by magster on Mon Dec 14, 2009 at 10:05:40 AM EST
    here

    There's just no reason not to use it.

    If Booman wants it (5.00 / 1) (#18)
    by TeresaInSnow2 on Mon Dec 14, 2009 at 11:32:40 AM EST
    then we must do it.

    ;-).

    Parent

    NOT ! :) (5.00 / 1) (#26)
    by Militarytracy on Mon Dec 14, 2009 at 11:55:11 AM EST
    He was at one point fine with encouraging people to spit on the troops!  That was before his precious became commander in chief though....so now you don't spit on us even though we are all the same people and the only thing that has changed is who the President is :)  But ummmmm..... I'm just not of the notion that if Booman wants something, that is a good indication that it is a good thing for the rest of us :)

    Parent
    That was the turning point for me (5.00 / 1) (#33)
    by Socraticsilence on Mon Dec 14, 2009 at 12:52:49 PM EST
    seriously, what the hell was that about? Gotta love encouraging people to replicate a possibly apocryphal event which is seen as a low point in American opposition to Vietnam. It's amazing that KOS's far, far more explicable comments are bandied about as the embodiment of the Netroots oppostion to the troops/American Values (Kos's infamous "screw them" remarks were directed towards mercenaries, which considering the guys background is probably a sore spot for him).

    Parent
    I said screw them too in that post (none / 0) (#38)
    by Militarytracy on Mon Dec 14, 2009 at 01:13:50 PM EST
    It was a terrible thing to happen, but soldiers were very upset about the mercs over there and wow did they just shoot everything up whenever they wanted to.  They were making more money than our soldiers ever dream of and they were creating so much collateral damage that was placing our soldiers lives at greater and greater risk with each passing day.  The mercs were very bloodthirsty, it was gross.  Anyhow, in Kos' post I said the same thing and then some dude who claimed he was special forces started cyber stalking me and that freakshow "catnip" made sure to give him my real name.  She's a piece of work too.  Because the guy claimed to be military though I think my spouse asked for him to be checked out.  Soldiers aren't supposed to stalk civilians :)  Then he just disappeared after that.

    Parent
    Exactly (none / 0) (#44)
    by Socraticsilence on Mon Dec 14, 2009 at 02:21:18 PM EST
    and then add in Kos's whole- either first or second generation immigrant from Central America thing- a region that was basically a free-fire zone for mercenaries for much of the second half of the 20th century-- the only place of origin that would leave person less sympathetic to mercenaries is Sub-Saharan Africa (was going to say Central Africa but then I remembered Angola and Rhodesia).

    Parent
    spitting (none / 0) (#46)
    by DancingOpossum on Mon Dec 14, 2009 at 03:34:30 PM EST
    a possibly apocryphal event

    From everything I've read, the story of people spitting on Vietnam vets is completely untrue and probably a fiction of fevered Republican imagination.

    I disapprove of spitting on troops, or anyone for that matter, but I also disapprove of the American tendency to revere the military, and the constant haranguing that I "thank" them for their "service."

    Selling The Sell Out On HCR | 48 comments (48 topical)

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