The Argument For Public Insurance

Ezra Klein writes:

The key to cost control is a politics that forces Congress to make the hard decisions that lead to cost control. Right now, the ranks of the uninsured grow, the cost of insurance rises, and Congress can pretty much ignore the whole thing. The individual mandate controls average premium costs, but more than that, it is the political mechanism for cost control. Kill it, and you've killed our best hope of making the next reform better than this one.

The next reform? Ha! Actually, Ezra has it precisely backwards.The mandate is the bargaining chip necessary for putting health care reform on the table. We are not getting reform in this bill and if you give up the mandate now you will NEVER get reform. [More...]

More importantly, Ezra actually explains why public insurance programs are the best cost control reform - because there is an absolute built-in pressure on the Congress to control costs - it is a federal program. Mandates are no pressure on the Congress. They are a handout to the health insurance industry. A mandate to buy public insurance however, is the most effective cost control of all. In the end, this really tells you about Ezra Klein's views on health care reform - uninterested in the facts of cost control through public insurance (see Medicare and Medicaid), fascinated by the unproven magical exchanges and the "market" for private insurance.

Speaking for me only

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    Seems this is nothing more than politics (5.00 / 2) (#5)
    by Inspector Gadget on Wed Dec 16, 2009 at 03:14:34 PM EST
    No one is working toward getting a true reform bill that meets the needs of the people and the industry.

    Obama wants so much to have this bipartisan that he is giving in to all the Republican demands.

    The Republicans want a bill that feeds dollars to their buddies in big insurance.

    The bill will be passed by the anything is better than nothing Democrats even though it's the bill the Republicans want.

    Republicans get their way and get to blame the Democrats for not doing a thing for the working class and uninsured.

    This is also (5.00 / 1) (#14)
    by cal1942 on Wed Dec 16, 2009 at 03:33:14 PM EST
    the bill that Obama wanted.

    This is what he meant about 'changing the tone in Washington.'

    Moving the Democratic Party to the right.

    Mission Accomplished.


    Democrats Now To The Right (5.00 / 1) (#60)
    by norris morris on Wed Dec 16, 2009 at 04:53:47 PM EST
    We now have a brand new Party we didn't know we had. Imagine.

    The party once known as rhe Democratic Party is now the Democratic Wealth Party.

    Change has certainly come as delivered by Obama, but the Hope is fading fast.


    Obama is an Eisenhower (none / 0) (#70)
    by Coral on Wed Dec 16, 2009 at 05:05:18 PM EST
    Republican. Think Eisenhower, those "moderate" GOP types who controlled the party until the Reagan revolution unleashed the harpies who rule the party now.

    Of course context (none / 0) (#87)
    by cal1942 on Wed Dec 16, 2009 at 05:23:43 PM EST
    should be regarded but I think Obama is slightly to the right of Ike and Nixon for that matter.

    Well its long been said (none / 0) (#114)
    by Socraticsilence on Thu Dec 17, 2009 at 02:05:11 PM EST
    that Bill Clinton was the Best Republican President since Eisenhower, now he has some competition.

    Politics and HealthCare (none / 0) (#116)
    by norris morris on Thu Dec 17, 2009 at 02:45:29 PM EST
    Without the ability to bargain through a public option there is no possibility of ever changing this crapola bill LATER.

    This is all politics and Obama shamefully caved to Big Pharma and Health Insurance for his re-election insurance$$$$$.

    There is no way this bill can be improved later. And later can mean 10 or 20 years as it's as hard to adjust or change law as it is to make law.

    So politics has trumped Obama's promises, and we watch an out of control Democratic party behave
    like spineless wanderers who in their hurry from pressure by the White House hope to jam this tripe down our throats.

    Newest political WH strategy is Obama warning us with scare tactics ala Cheney that doomsday is imminent if we don't get his bill.


    Ezra thinks that Medpac and the excise tax (5.00 / 2) (#7)
    by andgarden on Wed Dec 16, 2009 at 03:19:30 PM EST
    are cost controls. Unreal.

    Well if you cannot afford the copays and (5.00 / 1) (#12)
    by MO Blue on Wed Dec 16, 2009 at 03:29:03 PM EST
    deductibles and do not use your overpriced insurance, you will not get needed health care but the amount spent on services will go down.  

    Bankruptcy is new 'public option' (5.00 / 2) (#72)
    by Coral on Wed Dec 16, 2009 at 05:06:47 PM EST
    Healthcare prices go down? (none / 0) (#52)
    by norris morris on Wed Dec 16, 2009 at 04:42:13 PM EST
    Your logic is faulty.  There are penalties for refusing to signing up to this.  If you earn enough to afford to pay and do not, there are penalties,fines, etc.

    This also does not address the  healthcare problems that Obama promised to reform.

    It even penalizes women's equal protection rights more than the Republican Hyde bill does.

    Democrats have hit an all time low.


    Maybe my comment was not clear (5.00 / 1) (#59)
    by MO Blue on Wed Dec 16, 2009 at 04:53:08 PM EST
    A person purchases the minimum allowable insurance coverage because of the mandate. That monthly expenditure stretches his/her budget to the very limit. The person gets sick but there is an $1,000 deductible on the policy. Feeling they cannot afford the visit to the doctor since they will have to bear the entire expense, they do not go. The person does not receive health care and because no money is spent for that period it looks like health care expenditures have gone down.

    Indeed (none / 0) (#9)
    by Big Tent Democrat on Wed Dec 16, 2009 at 03:21:53 PM EST
    You know what the real threat is? (5.00 / 1) (#11)
    by andgarden on Wed Dec 16, 2009 at 03:26:32 PM EST
    We're going to end up with mandates and no subsidies. Who thinks the 112th Congress will extend subsidies?

    That we are . . . (none / 0) (#16)
    by nycstray on Wed Dec 16, 2009 at 03:39:08 PM EST
    count your blessings that you're young. It will be awhile before they charge you 3X's as much . . . unless, of course, you get sick or have a chronic condition . . .

    Hm (none / 0) (#15)
    by Steve M on Wed Dec 16, 2009 at 03:37:35 PM EST
    Isn't the excise tax a cost control?  If insurance companies price their policies over a certain amount, they have to pay a tax.

    Sure (5.00 / 5) (#22)
    by Big Tent Democrat on Wed Dec 16, 2009 at 03:46:40 PM EST
    No health care is also a cost control.

    As an insider (5.00 / 1) (#34)
    by Steve M on Wed Dec 16, 2009 at 04:14:23 PM EST
    I have super secret information regarding how much profit an insurance company makes on policies it doesn't sell.  Maybe if you ask nicely I'll reveal it.

    Point being? (5.00 / 1) (#50)
    by Big Tent Democrat on Wed Dec 16, 2009 at 04:38:52 PM EST
    Selling a crappy policy with less coverage can be extremely profitable even if it costs less.

    That's true (none / 0) (#53)
    by Steve M on Wed Dec 16, 2009 at 04:44:36 PM EST
    but what do you propose to do about the existence of junk insurance, given that we clearly aren't getting a robust public option?

    Medicaid expansion (5.00 / 2) (#61)
    by Big Tent Democrat on Wed Dec 16, 2009 at 04:56:12 PM EST
    Broaden the political constituency for it and put pressure on Congress to make it better.

    I have become convinced that the end goal should be single payer - not so much to eliminate insurance companies - but to incentivize completely the cost control pressure on the health care system itself.

    The government has been the only effective cost control agent.

    The government provides the best balance of concern for quality of care and cost of care.

    In short, Medicare for All is more than a slogan.


    The excise tax on policies that provide (5.00 / 2) (#65)
    by MO Blue on Wed Dec 16, 2009 at 04:58:46 PM EST
    good coverage will result in more people having crappy insurance with limited coverage.

    It will shift more and more of health care expenses onto individuals. If they cannot afford the additional expense, they will not get or seriously delay getting the health care they need.  


    I don't follow (none / 0) (#73)
    by Steve M on Wed Dec 16, 2009 at 05:06:56 PM EST
    there's plenty of room to get good coverage without paying the excise tax.  My insurance coverage is first-rate and it doesn't cost anywhere close to the excise tax range.

    I really hate how TL gets caught up in these narratives like "the government is mandating that we all buy junk insurance" that no one ever seems to question.


    I think the fear is, and I don't think it's (5.00 / 2) (#91)
    by Anne on Wed Dec 16, 2009 at 05:27:08 PM EST
    an unreasonable one, that insurance companies will see an opportunity to increase their profits by offering less-than-excellent coverage for what excellent coverage used to cost (if that makes sense).

    I have good coverage, too, although I am older than you are, which puts me in a different rating category; my insurance is going up almost 20% in 2010, to almost $700/month, which puts me close to Cadillac range, doesn't it?  My choice is to bite the bullet and pay it, or get a less inclusive plan, or increase my deductible - so I could pay less in premiums, but more out-of-pocket, which would discourage me from using it, so the only one who wins here is...CareFirst BCBS.

    Given the history of insurance company tactics and practices, I'm not sure we can tsk-rsk at anyone who fears he or she will end up with cr@ppy insurance.


    Well the CBO commented on this (5.00 / 2) (#93)
    by MO Blue on Wed Dec 16, 2009 at 05:52:15 PM EST
    The CBO predicts that seven years from now (in 2016), even if the Senate bill passes, an average family policy will cost $20,100 a year. That is roughly $7,000 more than it is today.

    In the large group market, which is defined here as consisting of employers with more than 50 workers, the legislation would yield an average premium per person that is zero to 3 percent lower in 2016 (relative to current law).
    In the large group market, average premiums would be roughly $7,300 for single policies and $20,100 for family policies under the proposal, compared with about $7,400 and $20,300 under current law. CBO

    It is my understanding that the current limits are $8,500 for an individual and $23,000 for a family.  Some more from CBO.

    In reaction to the tax, many employers would reduce the scope of their health benefits. The resulting reductions in covered services and/or increases in employee cost-sharing requirements would induce workers to use fewer services. Because plan benefit values would generally increase faster than the threshold amounts for defining high-cost plans (which are indexed by the CPI plus 1 percent), over time additional plans would become subject to the excise tax, prompting those employers to scale back coverage.

    I guess the CBO is promoting a faulty narrative.


    I am missing (none / 0) (#95)
    by Steve M on Wed Dec 16, 2009 at 06:07:06 PM EST
    where there is one single, solitary word in the CBO report about how the insurance will be "junk insurance."

    My point is that you can scale back a policy that is subject to the excise tax and still have an excellent policy.  You're acting like all the good insurance plans will be taxed out of existence.


    The current trend is that each year people (5.00 / 2) (#97)
    by MO Blue on Wed Dec 16, 2009 at 06:49:42 PM EST
    pay more for less coverage. My understanding when I read this "Over time additional plans would become subject to the excise tax, prompting those employers to scale back coverage is that this will accelerate this trend."

    Your current plan has an actuarial value (provides an estimate of the proportion of health care expenses a plan likely will pay) of 80 and is then subject to the excise tax. Employer then only offers a plan with an actuarial value of 70 to avoid the tax. A few years from then maybe it needs to 60 or 65 to avoid the tax.

    The minimum actuarial value in the Senate bill is 60 and subsidized coverage has an 70 actuarial value.

    Maybe you can afford to pay 30 to 40 percent of all your medical expenses but many people can't.


    This is certain to draw a rebuke from (none / 0) (#75)
    by oculus on Wed Dec 16, 2009 at 05:09:24 PM EST
    our diarist.  Blame it on the commenters, or Lieberman, or whomever.

    True (none / 0) (#78)
    by Big Tent Democrat on Wed Dec 16, 2009 at 05:11:11 PM EST
    Blame it on Lieberman Steve.

    As Nate Silver has informed us, all of our concerns are because we hate Lieberman dontcha know?


    Isn't he the baseball stats. guru? (none / 0) (#80)
    by oculus on Wed Dec 16, 2009 at 05:13:27 PM EST
    What does it take to blog about health care reform?

    Do you seriously advocate the feds (none / 0) (#79)
    by oculus on Wed Dec 16, 2009 at 05:11:34 PM EST
    require insuring family as opposed to buying big screen TV?  Heresy.

    Does the current bill consider Medicare (none / 0) (#82)
    by oculus on Wed Dec 16, 2009 at 05:14:46 PM EST
    plus Medicare supplemental policy subj. to excise tax?

    I have super secret information (none / 0) (#38)
    by MO Blue on Wed Dec 16, 2009 at 04:19:38 PM EST
    on how much profit an insurance company makes on a policy that charges a customer a premium but does not pay for health care.

    And they pass the cost on to us! (none / 0) (#17)
    by nycstray on Wed Dec 16, 2009 at 03:39:34 PM EST
    Oh right (none / 0) (#19)
    by Steve M on Wed Dec 16, 2009 at 03:41:56 PM EST
    except then they'd get taxed even more...

    I thought the tax had already (5.00 / 1) (#20)
    by nycstray on Wed Dec 16, 2009 at 03:44:27 PM EST
    been passed on to us in the form of the tax on the so-called Cadillac plans that would effect more people than people think?

    Same tax (none / 0) (#24)
    by Steve M on Wed Dec 16, 2009 at 03:53:48 PM EST
    the insurance companies are the ones who get taxed in the first instance.

    Look, I'm not disagreeing with the narrative that as soon as this bill passes, insurance companies will jack up all their prices to eleventy kajillion dollars per year and there's nothing anyone can do about it.  That seems entirely plausible to me.  But if there's no plan being offered in your price range then you're exempt from the mandate, so bear that in mind.


    Who decides what you can afford? (5.00 / 1) (#30)
    by nycstray on Wed Dec 16, 2009 at 04:07:54 PM EST
    The government (none / 0) (#33)
    by Steve M on Wed Dec 16, 2009 at 04:13:34 PM EST
    Yes, that same nasty, evil government which decides where to set the poverty line and who gets food stamps and who doesn't will get to decide how much of a subsidy people need in order to afford health insurance.  Can you believe there are actually people who want to give the federal government that kind of control over our health care?!?

    The bill (5.00 / 2) (#51)
    by Big Tent Democrat on Wed Dec 16, 2009 at 04:40:56 PM EST
    provides for 8% of AGI.

    So if you make 50k, you have to spend 4k a year. Or pay the tax, which would be 750 per person or 2,250 for a family.


    Sounds suspiciously like (5.00 / 1) (#64)
    by Zorba on Wed Dec 16, 2009 at 04:58:43 PM EST
    extra money for the Treasury (i.e. taxes, without calling it a tax raise) from those who cannot afford the tab for health care insurance.  If you are making $50,000/year as a family, $4,000/year is a healthy chunk of change when you have to raise kids, pay for daycare, feed them, and pay a mortgage or rent, utilities, etc (and good luck finding a policy that only costs 4k).  It's cheaper for them to pay the fine and pray that nobody gets sick.

    You're right -- unless premiums fall .... (5.00 / 1) (#108)
    by katiebird on Wed Dec 16, 2009 at 10:19:15 PM EST
    There might not be any plans for a family of 4 at $4,000/year.  

    In my family there are just two of us and we're paying almost $10,000/year. (and that's WAY over 8% of our income)


    I think it's reasonable (none / 0) (#69)
    by Steve M on Wed Dec 16, 2009 at 05:05:11 PM EST
    I know it's difficult to make ends meet, but it is not asking too much for that family to come up with 4 grand for something as critical as healthcare.

    I would, of course, prefer single-payer financed through progressive taxation, but if it's unthinkable to ask that family to come up with $4000, basically we're in a position where we're stuck with the status quo unless we can pass a plan that gives half the population free health care.


    It's about as much as a car payment, (5.00 / 3) (#83)
    by Anne on Wed Dec 16, 2009 at 05:16:48 PM EST
    I guess; I suppose the problem I have is that I think it's impossible to declare what is affordable for every family making X dollars per year.  

    I remember when my older daughter was looking at colleges, and I was filling out the FAFSA forms to see what our expected family contribution would be - when it informed me that we would be expected to contribute something like $18,000 a year, I laughed out loud: if we could afford to shell out $18K a year (was there a money tree somewhere on our property that we didn't know about, perhaps?), I wouldn't be filling out financial aid forms!  Hello?!?

    I don't think this is that much different, when all is said and done.


    That's where I'm at (none / 0) (#90)
    by nycstray on Wed Dec 16, 2009 at 05:26:22 PM EST
    What I can afford today is going to drastically change in 2 mos when I move, but my income sure isn't! My housing will double, I'll need a car and all the insurance and other costs that go with it and now the government is going to say how much I can afford for insurance? Again, my income will be the same.

    And in this economy, we can all afford a new car payment . . . .


    How come we pay over $300 (none / 0) (#107)
    by Militarytracy on Wed Dec 16, 2009 at 10:10:12 PM EST
    a month and a Canadian family of four pays $200 a month?

    I'd like to see (5.00 / 2) (#86)
    by Zorba on Wed Dec 16, 2009 at 05:23:36 PM EST
    a comprehensive health insurance plan that only costs $4,000/year.  Without a huge deductible and enormous co-payments that make it virtually useless.

    The point is (5.00 / 1) (#106)
    by TeresaInSnow2 on Wed Dec 16, 2009 at 09:59:37 PM EST
    you can't insure a a family of 4 for 4 grand.....

    Are you going to rely on subsidies?  LOL!


    Of course (none / 0) (#109)
    by Steve M on Wed Dec 16, 2009 at 11:42:47 PM EST
    the subsidies are in the bill, why would I not rely on them?  In any event I was just answering the question that was posed to me.

    If paid to a public insurance plan (none / 0) (#74)
    by Big Tent Democrat on Wed Dec 16, 2009 at 05:09:02 PM EST
    I agree with you.

    What (none / 0) (#85)
    by Zorba on Wed Dec 16, 2009 at 05:21:39 PM EST
    "public insurance plan"?  Doesn't look like that's currently on the table, and I don't expect that any "exchanges" will lead to any family plans that only cost 4k/year.

    the current plan is not reasonable (5.00 / 1) (#89)
    by Big Tent Democrat on Wed Dec 16, 2009 at 05:26:02 PM EST
    I'll certainly agree (none / 0) (#96)
    by Zorba on Wed Dec 16, 2009 at 06:08:30 PM EST
    with that, BTD.  The current plan seems like a whole lotta nothin'.

    Then what does a single person have to (none / 0) (#76)
    by nycstray on Wed Dec 16, 2009 at 05:09:57 PM EST
    come up with? I don't think that's the fam of 4 rate is it? If so, wouldn't that be much cheaper than they are paying now (at least in NY)?

    Thanks (none / 0) (#57)
    by nycstray on Wed Dec 16, 2009 at 04:49:12 PM EST
    So are you saying (none / 0) (#37)
    by nycstray on Wed Dec 16, 2009 at 04:18:27 PM EST
    that if you don't qualify for a subsidy you aren't mandated? Or if you don't qualify for a subsidy, the government "assumes" you can afford it and are therefore mandated?

    You are mandated (none / 0) (#42)
    by Steve M on Wed Dec 16, 2009 at 04:26:21 PM EST
    as long as there's a policy available that's within your price range, as determined by the government.  Believe me, I don't pretend to understand all the details.

    Correct (5.00 / 2) (#62)
    by Big Tent Democrat on Wed Dec 16, 2009 at 04:57:27 PM EST
    the subsidy is dependent on whether the government thinks you need it to attain affordable coverage.

    Oy, that should be interesting . . . . (none / 0) (#45)
    by nycstray on Wed Dec 16, 2009 at 04:29:55 PM EST
    Price Range? (5.00 / 1) (#44)
    by norris morris on Wed Dec 16, 2009 at 04:29:51 PM EST
    Then this means if one cannot afford insurance then there is no insurance possible.

    Then we are worse off or no better off than before, once this onerous Wealthcare is law.

    This is a disasterous scenario.


    Bingo (5.00 / 1) (#88)
    by Zorba on Wed Dec 16, 2009 at 05:24:49 PM EST
    We have a winner!

    Just a though. (none / 0) (#29)
    by coast on Wed Dec 16, 2009 at 04:05:49 PM EST
    What does "eleventy kajillion" look like? I don't think I have ever written that number any financial statements that I have prepared. :)

    What Ezra and all the rest (5.00 / 2) (#21)
    by cal1942 on Wed Dec 16, 2009 at 03:45:14 PM EST
    don't get is that many millions of the uninsured can't possibly afford the one grand plus a month for private insurance and that many millions probably won't be able to afford private insurance if subsidies aren't sufficient to the extent that the whole tab is paid.

    Imagine how happy they'll all be when they have to fork over the fine. Guess who they'll blame?

    I'll bet they won't blame Lieberman.  They'll blame the whole Democratic Party.

    Back in the day (5.00 / 3) (#63)
    by Coral on Wed Dec 16, 2009 at 04:58:34 PM EST
    when my kids were toddlers, I was the primary breadwinner in my family, while spouse went back to school. On my paltry freelance income, I paid 500 to 600 per month for health insurance, plus 500 to 600 per month for childcare so I could work.

    Looking back now, I wonder how we survived. The answer is "just barely" and "increased debt."

    Kids out of college, still paying down debt. Sadly, now kids have no health insurance, and they'd be lucky to find as comprehensive insurance for a single, young adult for what I was paying two decades ago for a family of four. However, their income now, each, is about 1/2 of what I was making then.

    This is the story of the American middle class (and sinking slowly) in a nutshell.


    As well they should....n/t. (none / 0) (#100)
    by sallywally on Wed Dec 16, 2009 at 07:19:25 PM EST
    All I can say is that I fear for (5.00 / 9) (#23)
    by Anne on Wed Dec 16, 2009 at 03:47:49 PM EST
    what this administration has in mind for Social Security and Medicare, because if this little exercise they've been engaged in for the last eleven months is the template for how they will go about "fixing" those programs...well, I almost cannot bring myself to contemplate the possibilities.


    Yup (5.00 / 5) (#26)
    by cal1942 on Wed Dec 16, 2009 at 03:54:14 PM EST
    Only Nixon can go to China and only a Democrat will be allowed to ruin Social Security and Medicare.

    When Obama brought up Social Security funding during the primaries, people should have fled him as they would flee the plague.


    I did flee him (5.00 / 2) (#48)
    by Zorba on Wed Dec 16, 2009 at 04:34:40 PM EST
    during the primaries, but then, I'm an old leftie-hippie and a long-time Dennis Kucinich supporter (I know, I know, Dennis never, ever had a snowball's chance in Hades).  I only voted for Obama in the general election as the "lesser of two evils" (and I really, really couldn't stomach Caribou Barbie being a heartbeat away from the Presidency).  I don't know what I'll do next time.  I won't vote for Obama again, and I can't vote for a Republican.  Probably third party.  Or stay home.

    Third party....unless... (none / 0) (#66)
    by Coral on Wed Dec 16, 2009 at 05:00:43 PM EST
    I was going to say, unless the GOP nominee is Palin, but then I got to thinking about the other possibilities....

    But if some "moderate" GOP were running, I'd definitely go third party.


    This "health care reform" (5.00 / 2) (#46)
    by KeysDan on Wed Dec 16, 2009 at 04:31:40 PM EST
    already has Medicare in its sights.  Much discussion has been given to that half of funding for the bill that increases excise, fines, Cadillac or other taxes, but little serious attention has been given to that half that is to come from Medicare "savings".  No one seems to be able with any precision, to come up with the source of this savings. In fact, no one really asks.   Yes, Medicare Advantage plans are cited, but certain exemptions are now bandied about, savings on part D, drugs--that is a moving target, less payment to hospitals and other providers, changes from fee for service, but we already reimburse on DRG's, duplicative lab tests (Obama's contribution to the discussion), penalties for hospital-acquired infections, and re-admits (but already in place) and, of course, non-specified efficiencies.  On top of all this, we are also told that Medicare, itself, is on the ropes and will be in dire straits by 2017, just as the underwriting costs for the extended program kick-in.  Does anyone smell benefit cuts or eligibility raised to 70, after all, we will now have a good program that we can stay in awhile longer.

    The Next Reform? (5.00 / 3) (#55)
    by Militarytracy on Wed Dec 16, 2009 at 04:47:16 PM EST
    Are you kidding me?  First he tells me early on this negotiation that I have to take this one and be grateful because I won't get another, and now he tells me I have to take this one for the hope of the next one?  Why do I feel nuts?

    Surely we all remember (5.00 / 5) (#58)
    by Steve M on Wed Dec 16, 2009 at 04:52:47 PM EST
    the FISA bill that was going to get fixed after the election.

    Awwwwwk. (none / 0) (#71)
    by oculus on Wed Dec 16, 2009 at 05:05:19 PM EST
    The stupidest quote from this (5.00 / 2) (#81)
    by Militarytracy on Wed Dec 16, 2009 at 05:14:00 PM EST
    Ezra mental mindfrick is this

    Kill the individual mandate and you make it easy for Congress to let the country backslide to its current condition.

    How do I backslide to where I currently am?  How did this punk end up being a "whole enchilada" pundit when he hasn't even graduated from fries yet.  I'm outraged by the blatant stupidity, is it his or does he think I'm dumb enough to buy all this (in which case I'm insulted)?  Ezra, you can't sell me this B.S.  I'm older than you and I've been effed over many more times.  Slow down and listen to yourself Ezra.


    Same theory as "you are the change you've (5.00 / 4) (#84)
    by oculus on Wed Dec 16, 2009 at 05:17:40 PM EST
    been waiting for."  See how easy it is?

    It's best to look at Ezra ... (5.00 / 2) (#92)
    by Robot Porter on Wed Dec 16, 2009 at 05:33:00 PM EST
    as a minor Internet entrepreneur.

    As such, he's been moderately successful.

    By every other standard, he's a failure.

    I can never decide which annoys me more, his stupid apologia or his abysmal writing. The line you quote above is just one example of this.  He drops a clanger like that daily.


    First of all, (5.00 / 1) (#102)
    by JamesTX on Wed Dec 16, 2009 at 07:40:03 PM EST
    I am a liberal. I hated and protested against Richard Nixon, I kept the fires burning during the decade when everybody said we were a lost and out of touch generation. I never see anything from these right wingers' point of view, even when the typical new "progressive" takes conservative principles as given and adds a little flavor, somehow thinking they understand the essence of the liberal position.

    But I wonder how much our old relatives the libertarians could be on to something here. And sometimes I think we may actually have a representative democracy that has a tendency to come up with the best answer.

    My problem is this. In our mad, maniacal, rock-concert rush to get right up to the stage of public health care, it is clear that NOBODY, not one frigging screaming liberal, has worried in the very least about what controls there would be on the use of the medical records. NOBODY CARES. And you had better care!

    Maybe we don't want the government holding our medical records! Homeland Security will have their nasty little fingers in it in no time, if they already don't, looking for misfits and no-goods.

    Maybe it's not such a good idea.

    Now, go on with the pack and call me crazy.

    Klobuchar and Rockefeller on MSNBC (none / 0) (#1)
    by magster on Wed Dec 16, 2009 at 03:06:42 PM EST
    piling on Dean after Gibbs did this morning.

    Meanwhile, Nelson says he doesn't support the bill because of the abortion language.

    And so it goes....

    The White House (5.00 / 4) (#13)
    by cal1942 on Wed Dec 16, 2009 at 03:30:23 PM EST
    is wrapping up its plan and getting exactly what it wants.

    This summarizes the whole thing.

    We're now certain the White House will sign a crappy bill.


    Good post (5.00 / 1) (#99)
    by BackFromOhio on Wed Dec 16, 2009 at 07:11:32 PM EST
    thanks for link.  Also, transcript of Dean's interview with Keith Olbermann has Dean saying that under the anti-reform bill currently before the Senate, insurance companies can make older people pay more than younger people.

    I hope Dean refuses to shut up, and that the media keeps bringing him back.


    Dean is still the best the Dems have...n/t. (5.00 / 1) (#101)
    by sallywally on Wed Dec 16, 2009 at 07:37:46 PM EST
    IIRC it is 3 time more in the Senate bill (none / 0) (#105)
    by MO Blue on Wed Dec 16, 2009 at 08:45:16 PM EST
    Was there really (none / 0) (#25)
    by Zorba on Wed Dec 16, 2009 at 03:54:06 PM EST
    ever any doubt that the White House will sign a crappy bill?  I started to have suspicions about this when Obama refused to jump into the fray from the beginning and outline exactly what he wanted in a health care reform bill.  Instead, he left it all to the Congress.  All of which leads me to believe that he wanted a watered down, Insurance and Pharma friendly bill that he could then check off on his little list.  "Okay, health care 'reform.'  That's done."

    I am completely convinced that the (5.00 / 3) (#27)
    by Anne on Wed Dec 16, 2009 at 04:04:45 PM EST
    bill, as it's shaping up in the Senate, is exactly the bill the president wanted all along.

    If he could twist arms to get Dems to sign on to his war funding bill, he sure as hell could have twisted arms to get a good reform bill, if he wanted one to begin with.  He didn't - all the deals and all the cash accrue to the industry, not to us.

    Obama may still be the light at the end of the tunnel, but - surprise! - he's the train coming right at us.


    I'm afraid (5.00 / 1) (#36)
    by Zorba on Wed Dec 16, 2009 at 04:18:12 PM EST
    that I have to completely agree with you, Anne.  This is certainly not "Change we can believe in."  It's the same-old-same-old, corporate-friendly, reverse-Robin-Hood agenda we've seen for years- transferring money from those who can least afford it to the wealthy corporations and individuals who fund all their campaigns (and on whom all of our elected representatives, up to and including the President, can rely for money/jobs/lucrative speaking fees after they leave public office).

    The Train Coming Ar Us (none / 0) (#40)
    by norris morris on Wed Dec 16, 2009 at 04:22:45 PM EST
    Thanks for your excellent post.

    The train has indeed left the station.


    A WEALTHCARE FOR OBAMA (5.00 / 1) (#39)
    by norris morris on Wed Dec 16, 2009 at 04:21:07 PM EST
    Yes Obama wanted to check this off his list. He's working towards bragging rights that he feels will net him an A.

    Who does he think he's kidding? This stuff doesn't kick in for a while, but when it does he will be in his second term if elected. By then he can blame it on the Republicans.  He knew damn well that no Republican would go for a public option but pretended to want bi-partisanship?

    The current Senate bill is the biggest corporate giveaway ever. 30 million unwilling victims to  Insurance and Drug monopolies that will totally control the marketplace.

    Unfortunately there hasn't been a grass roots groundswell against this as so many are Obamatons
    who fell for a dream and not a reality.

    I doubt there will be a progressive Democrat or moderate Independent that will continue to support Obama's prohibitive bait and switch policies.



    I agree, (5.00 / 2) (#43)
    by Zorba on Wed Dec 16, 2009 at 04:27:08 PM EST
    Norris morris.  I keep waiting for people to realize that they're being played, and start storming the barricades.  I'm too old and have too much arthritis to storm any more, myself, but I'd be willing to offer them whatever support I can.  (And I do what I can, already, calling and writing to my fairly useless reps, giving money to progressive causes and candidates.)  

    War on Crime and Drugs... (none / 0) (#77)
    by kdog on Wed Dec 16, 2009 at 05:10:51 PM EST
    killed any chance of storming the barricades Zorba...the police state my generation and the next has experienced has us either afraid or unconvinced it'll do anything more than get us locked up.  

    Maybe thats why so many bought "hope and change"...it feels and has felt hopeless and unchanging.  When the greatest "progressive" achievement of the last 30 years is a tax increase you know its fubar.


    You may be right, kdog (none / 0) (#104)
    by Zorba on Wed Dec 16, 2009 at 08:03:23 PM EST
    But I have to say that my generation (the anti-Viet Nam War and the Civil Rights generation) faced many police-state tactics ourselves.  The government-sponsored arrests, intimidations, killings, and harassments were pretty bad, and yet we were not silenced.  The police state now may be more technologically sophisticated, but I know that many of us have FBI files dating from that era, and I'm not sure that it's any worse now than it was then, except for the higher-tech capabilities of the government.  

    No doubt... (none / 0) (#111)
    by kdog on Thu Dec 17, 2009 at 10:13:27 AM EST
    the billy-clubs, the dogs...you guys faced down a police state.  I just feel its more expansive and invasive now...so many more cops in uniform, more surveillance, and the new tactics and technologies.  When the cointelpro sh*t went down it was kind of unprecedented...now it is known and expected that the state will stop at nothing to maintain status quos...that scares me.

    And we've got less to lose...no draft.  Generally easier lazier lives...though that tide may be turning.  And I don't discount the possibility your generation just had more balls...we may need some of you old-timers to show us whipper-snappers the way to the barricade without getting tased and caged, or at least getting tased and caged for some benefit that can be seen.


    When it gets (none / 0) (#112)
    by Zorba on Thu Dec 17, 2009 at 10:32:17 AM EST
    bad enough, you "whipper-snappers" will go the barricades.  You are not less brave.  We were not even "brave" so much as acting out of sheer necessity to end situations that had become intolerable.

    Hope you're right Z... (none / 0) (#113)
    by kdog on Thu Dec 17, 2009 at 11:06:28 AM EST
    and what a shame it has to become intolerable before we grow a pair...human nature I guess.

    To be fair, he is only looking for an A-. (none / 0) (#47)
    by KeysDan on Wed Dec 16, 2009 at 04:34:23 PM EST
    That's cold, (none / 0) (#56)
    by Zorba on Wed Dec 16, 2009 at 04:48:24 PM EST
    KeysDan.  Cold, but accurate.  ;-)

    Not an AP course, I gather. (none / 0) (#67)
    by oculus on Wed Dec 16, 2009 at 05:00:43 PM EST
    New poll on health insurance profit bill (5.00 / 2) (#35)
    by MO Blue on Wed Dec 16, 2009 at 04:17:03 PM EST
    The NBC/Wall Street Journal poll coming out later today will show opposition to the health care bill growing -- mainly from disappointed liberals, who are very much disappointed to see the public option getting thrown out.

    The poll has 47% saying the Obama health care plan is a bad idea, to only 32% who say it's a good idea. link

    Its 1993 (none / 0) (#115)
    by Socraticsilence on Thu Dec 17, 2009 at 02:11:08 PM EST
    all over again. Man, maybe we need to stop having our presidents attempt to reform Healthcare nothing gets done and we lose congress.

    If WH Anonymice rap Dean's critique as a tantrum (5.00 / 1) (#94)
    by Ellie on Wed Dec 16, 2009 at 06:03:30 PM EST
    Then WTF do they call this stompy little parade out of the clown car? (It got barfed into the wires in time for the evening news.)

    For one thing, Nelson can't be the lone holdout if he's merely the first staller cited. (As for "moderate" ... )

    In another twist of pretzel logic, double-smacking (Independent) Sanders -- presented first as a Dem, and later alluded-to in the same article as a pesky liberal who must eat it -- just begs the question of why all must bow to "Independent" Joseph I. Lieberman (I-Joseph I. Lieberman) in the name of bipartisanship, but not Independent Sanders.

    GOP delay tactics slow Dems on health care votes by By Ricardo Alonso-zaldivar And Ken Thomas, AP

    WASHINGTON - Senate Democrats' drive to pass the health care overhaul by Christmas sputtered Wednesday as a lone moderate holdout remained undecided and Republican delaying tactics stretched an already protracted debate even further.

    Despite a one-on-one meeting Tuesday with President Barack Obama that lasted 30 minutes, Sen. Ben Nelson, [D-Coat Hanger], said he still has concerns about abortion and other issues. Nelson, the only known holdout among 60 senators whose votes are needed to move the bill, said it had been his third meeting in eight days with the president.

    Obama "made a strong case for passing health care reform now," said Nelson. "But I think it still remains to be seen if it was compelling." The legislation needs to be improved, he added, and liberals resisting his proposals -- even saying the bill should be scrapped -- are running out of alternatives. [...]

    To make matters more complicated, the Senate stumbled into health care gridlock after a Republican senator forced the clerk to read aloud a 767-page amendment.

    GOP Sen. Tom Coburn of Oklahoma had sought approval to require that any amendment considered by the Senate must be offered 72 hours in advance and with a full cost report.

    When he was rebuffed by Democratic Sen. Max Baucus of Montana, Coburn invoked his right to require that an amendment by another Democrat be read aloud. That sent the Senate into limbo, since the amendment by Vermont Independent Bernie Sanders is 767 pages long. It calls for guaranteeing coverage to all through a public program similar to Medicare and is not expected to pass.

    Obama cajoled restive Democrats on Tuesday, urging them not to lose perspective amid intense intraparty battles over government's role and reach in health care. The public plan liberals hoped for appeared dead in the Senate, as did a Medicare buy-in scheme offered as a fallback.

    "The president and vice president pointed out that you take your victories when you can and nothing prevents you from fighting on for the things you believe should have been achieved," said Sen. Sheldon Whitehouse, D-R.I. "But why spurn a victory in hand?"

    Sen. Mary Landrieu, D-La., a moderate who had been on the fence, said Tuesday night it's time to pass the bill. [... more hooey ...]

    So many big @sses, such a tiny clown car. How is this a shared "victory" for liberals? Liberals get nothing, are blamed for the obstructionism of jackwads like Nelson, and are continually, perfunctorily smacked to show that Obama's Dems are being serious about health coverage (as opposed to real health care)?


    An answer for you (none / 0) (#110)
    by jbindc on Thu Dec 17, 2009 at 07:16:41 AM EST

    Sen. Joe Lieberman (I-Conn.) is taking a thrashing from his former Democratic colleagues and liberal activists for forcing a Medicare expansion out of the health bill.

    But in the end, Lieberman may have done President Barack Obama one of the biggest favors in the health care debate.

    That's because any bill with the Medicare buy-in would have drawn fierce opposition from doctors and hospitals, two groups Obama has worked hard to keep on board.

    In effect, Lieberman spared Obama from having to make a difficult choice down the road - between liberal supporters who wanted the Medicare expansion and two big constituencies whose opposition could have scuttled a bill.

    "They can't lose the hospitals or the docs," one health care lobbyist told POLITICO.

    Both groups hold big sway on Capitol Hill and, more importantly, in local communities where they can quickly mobilize grassroots opposition.

    Their muscle helped kill President Bill Clinton's reform effort more than a decade ago and it was on display again this past week when word spread that Senate negotiators were considering expanding Medicare to younger seniors, ages 55 to 64.

    In less than a week, the groups mobilized and succeeded in beating back the plan. The episode illustrates why Obama has sought to keep the two influential health care stakeholders as allies, not adversaries.

    And as the Senate writes the fine print in the bill, the quick demise of the buy-in shows how quickly the two constituencies were able to shift the ground in Washington to block something they didn't like.

    Stupak (none / 0) (#2)
    by Big Tent Democrat on Wed Dec 16, 2009 at 03:07:52 PM EST
    Can that be swallowed WITHOUT a public option? I am not sure.

    Yes (5.00 / 3) (#32)
    by Emma on Wed Dec 16, 2009 at 04:09:49 PM EST
    Simple answers to simple questions.  And it will pass without a public option.  Just watch.

    It can't be swallowed at all. (none / 0) (#3)
    by nycstray on Wed Dec 16, 2009 at 03:09:10 PM EST
    It passed the House (none / 0) (#4)
    by Big Tent Democrat on Wed Dec 16, 2009 at 03:10:48 PM EST
    Wealthcare From Obama (5.00 / 2) (#31)
    by norris morris on Wed Dec 16, 2009 at 04:08:00 PM EST
    There is no reform possible without a public option. This is Wealthcare for the insurance and drug monopolies and laying it at the feet of Joe Leiberman is disingenuous.

     It belongs to the lost leadership of Obama who has clearly sided with Corporate America and gave away the store from he beginning of his Presidency. He has never used his power to fight for more.

    What Obama says is not what he does,and it's also infuriating that Pelosi's lack of leadership allowed the Stupak amendment into the House bill.

     The Hyde bill already exists which specifically prohibits federally funded abortion. Stupak goes several steps further and limits women's rights to pay for abortions themselves. Outrageous.Written by a Democrat and the Catholic Church.

    So Obama gave himself a B+???  For Wealthcare that hands 30 million to Private Insurance & Drug Monopolies with no other option left to the public that could insure fair pricing of insurance?

    There is no incentive for Insurance to lower premiums as these anti trust monopolies can do as they wish. Big Insurance will continue to control healthcare. There is no guarantee they will honor pre-existing condition provisions. With a weak president and congress they know they can buy themselves out of it.

    Rham Emannuel is running to Reid asking for any bill just a bill..ASAP... This tells us that Obama needs to continue to hoodwink us a sham bill that needs to be defeated. Changing and adding to bills is extremely difficult, and the only way to have a decent bill is by killing this one and starting again.

    This upsets the plans of Obama's B+ assessment, but really, creating Wealthcare gets a big "D".

    We've been scammed.


    Oh, that was so then. So many (none / 0) (#6)
    by oculus on Wed Dec 16, 2009 at 03:18:26 PM EST
    sd. they will vote against next time.

    Who believes that? (none / 0) (#8)
    by andgarden on Wed Dec 16, 2009 at 03:19:47 PM EST
    Not I. (none / 0) (#10)
    by oculus on Wed Dec 16, 2009 at 03:24:11 PM EST
    Oh I know (none / 0) (#18)
    by nycstray on Wed Dec 16, 2009 at 03:40:27 PM EST
    I was just having a moment :P

    with out a public option (none / 0) (#49)
    by TeresaInPa on Wed Dec 16, 2009 at 04:38:04 PM EST
    there is no need for the stupak/Pitts debacle.

    No bill at all is becoming more likely (none / 0) (#68)
    by Coral on Wed Dec 16, 2009 at 05:03:46 PM EST
    Up to a couple of days ago, I thought we'd end up with something really lousy.

    Now, it looks as if there's a growing possibility that no bill will be able to pass the 60 vote test in the Senate and then manage to get through conference, plus Senate and House again.


    If only.....n/t. (none / 0) (#103)
    by sallywally on Wed Dec 16, 2009 at 07:45:51 PM EST
    A Christmas Dream (none / 0) (#28)
    by Missblu on Wed Dec 16, 2009 at 04:05:19 PM EST
    In reading these accounts about the ignorant thinkers we have in Congress supported by people like Klein who have no serious critical thinking skills to appreciate the importance of this bill as it was understood to by the progressives who supported it in the beginning.  it just gave me an idea. Maybe it is time for a new party to be headed by Howard Dean. It will be born in 2010 and be the Universalists party.  Devoted to carrying out the real meaning of the constitution, they will seek life, liberty and the pursuit of happiness without shame and with pride. Number one issue on their platform will be a single payor U.S. Universal healthcare system bringing the United States in line with all other smart developed countries.

    The media will not like the Universalist party and especially Howard Dean so we must have a really cagy strategist leader able to see behind every action to thwart the strength of this movement by them and possesses a brilliant lawyer 's mind fully in tune with political law.  So many people who never would have embraced such a concept are now ready for this.  I nominate Big Tent as the strategist to bring this party into the light. It will start as a real publicly financed party.

    Cost control? (none / 0) (#41)
    by coast on Wed Dec 16, 2009 at 04:25:39 PM EST
    How does this bill in any way produce meaningful cost control?  My problem with this whole process has been the misunderstanding that insurance is the sole mechanism for controlling health care cost.  Insurance is merely a by product of runaway cost at the provider level, not the intermediary.  You say that you are going to control gas prices by controlling your auto insurance or that you can control your gas or water bills by controlling your home owners insurance.  Granted, the insurance industry was in need of reform for thing like dropping individuals from coverage, denying claims, and denying coverage for pre-existing conditions.  But controlling insurance prices does not fix the problem at the provider level.  Insurance companies may negotiate harder on the rates they promise providers, but the negotiations start at a certain cost that the provider establishes.  If the provider has set that initial cost extremely high, then what are we really getting.  My carrier's "negotiated" rate for an MRI is about $4,000.  Why the he$$ does a glorified x-ray cost as much (or more than) a used car.  Cost control for health care should start at the provider level.  This whole thing has nothing to do with controlling the cost of health "care".  

    agree (5.00 / 1) (#98)
    by TeresaInPa on Wed Dec 16, 2009 at 07:04:45 PM EST
    most people go in to health care anymore with the assumption they deserve to get rich. Why?

    No Cost Containment (none / 0) (#54)
    by norris morris on Wed Dec 16, 2009 at 04:47:02 PM EST
    As you say the basic problem is cost containment and realistic approaches in tandem with making healthcare affordable.

    But it would be far too optimistic to expect the knuckleheads in the Senate and the House to do this as they are all beholden to the Healthcare/Drug lobby.