"If Health Care Reform Dies . . ."

"'Health Care Reform' has only suffered a flesh wound." - Village Bloggers (h/t KD commenter.)

As part of the Village Bloggers' attack on Howard Dean, I enjoyed our friend Kevin Drum's turn of phrase:

If healthcare reform dies this year, it dies for a good long time.

If? Oh. I see. The Senate bill is "health care reform" for Kevin. Let's count the reasons why:

* Insurers have to take all comers. They can't turn you down for a preexisting condition or cut you off after you get sick. [How much can they charge you for that?]

* Community rating. Within a few broad classes, everyone gets charged the same amount for insurance.

[A few broad classes? Hmmm. Define "a few broad."]

* Individual mandate. I know a lot of liberals hate this, but how is it different from a tax? And its purpose is sound: it keeps the insurance pool broad and insurance rates down. [It is like a tax where the purpose is to bribe the insurance companies to accept health care reform. How precisely it keeps insurance rates down is not apparent to me. I understand that broadening the risk pool is supposed to keep down rates but that is in a world of effective competition. Where's the reform on COMPETITION in this bill?]

* A significant expansion of Medicaid. [Let's wait to see what Nelson does to the bill first.]

* Subsidies for low and middle income workers that keeps premium costs under 10% of income. [See above. Let's wait for Nelson.]

* Limits on ER charges to low-income uninsured emergency patients. [Change you can believe in.]

* Caps on out-of-pocket expenses. [Not really. Kevin needs to read the fine print there.]

* A broad range of cost-containment measures. [HAHAHAHAHAH!]

* A dedicated revenue stream to support all this. [Which revenue stream is that? Oh, he means the excise tax. Um, I am pretty sure that one is regressive. Bad point Kevin.]

Look. I can see supporting this bill IF the Medicaid expansion stays in at current levels with the House financing mechanisms. the mandate is a high price to pay and unless it is sunsetted, kills any chance for real health care reofrm.

But the argument that Kevin forwards - that this bill is good health care reform is absurd. At this point, I do not agree with Howard Dean, but I see his argument - this bill DOES kill health care reform for a generation. By pretending to be reform. By giving up the mandate for so little.

At the heart of this is the Village Wonk belief that the Exchange will be the competition mechanism that can be expanded to be meaningful. howard Dean does not believe this. He believes that absent a public insurance component, there will be no meaningful competition and thus no meaningful reform.

This has been at the heart of this disagreement the whole time -- the Village bloggers' disdain for the public insurance programs as "reform" and "cost containment." Taken at face value, their view of health care reform is pretty much Joe Lieberman's (and that is perhaps why they launch vicious attacks on Lieberman - so this fact is not quite so apparent.)

It is an honest disagreement. It would be nice if the Village bloggers could be honest enough to acknowledge what the disagreement is.

Speaking for me only

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    I think the conclusion I have come to (5.00 / 3) (#4)
    by Anne on Wed Dec 16, 2009 at 07:27:38 AM EST
    is that the Village bloggers are just making the argument they believe Obama would be making, such that if Obama were out there excoriating the Senate for what is happening, so would the Village Bloggers.

    Of course, Obama isn't really making an argument, is he?  Is the lack of noise from the White House convincing enough proof that he does not object to what the Senate seems to be doing?  Or is this just typical, I-don't-want-to-get-REALLY-involved-until-I-see-where-it's-going Obama-schtick?

    This is not health care reform; this is about insurance in pretty much any direction you look at it from - it stopped being about health care almost from Day One.

    One thing I think I've noticed is that the Village Bloggers are starting to sound a little shrill, a little desperate, as they see this thing start to circle the drain - not for what the people might be losing out on, mind you, but for the horror of seeing their hero have to put one in the "L" column.

    They aren't even entertaining anymore.  

    I just watched Obama's transportation (none / 0) (#15)
    by Militarytracy on Wed Dec 16, 2009 at 08:20:41 AM EST
    secretary talk about how Obama's belief in bipartisanship is really a part of his DNA.  Looks like the only entity Obama will fight is the Taliban, and nothing more.  That just seems too wierd to me.

    It was never care (none / 0) (#18)
    by Inspector Gadget on Wed Dec 16, 2009 at 08:46:46 AM EST
    care from anyone. All candidate campaign promises were for insurance coverage - some with mandates, some without.

    I haven't seen anything on just what Obama said to the Democratic Senators when he went to speak to them yesterday or the day before about this. Where are those anonymous folks when we need them? Or, did Feingold leak the message? [he's going to get a phone call from the boss for
    "demeaning" now]


    What is being said. (5.00 / 1) (#21)
    by MO Blue on Wed Dec 16, 2009 at 09:03:05 AM EST
    "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?"
    But Obama got their attention, said Rockefeller, describing a health care remake to cover tens of millions now uninsured as "the biggest thing since Social Security."

    "It's hard to ignore that," Rockefeller said. link

    lol (5.00 / 2) (#5)
    by jedimom on Wed Dec 16, 2009 at 07:56:36 AM EST
    perfect clip!!!!!!


    So, having slept on this, here's what I think (5.00 / 1) (#8)
    by andgarden on Wed Dec 16, 2009 at 08:06:00 AM EST
    I would do if I were in the Senate. If the final bill has a mandate but no public option, I'd probably vote for cloture but against final passage.

    Wait to see the final bill first (none / 0) (#9)
    by Big Tent Democrat on Wed Dec 16, 2009 at 08:06:50 AM EST
    Well, I sure wouldn't want to be called (none / 0) (#10)
    by andgarden on Wed Dec 16, 2009 at 08:10:12 AM EST
    a racist for opposing the President.

    Well (none / 0) (#11)
    by Big Tent Democrat on Wed Dec 16, 2009 at 08:12:20 AM EST
    That community was destroyed years ago.

    I would expect nothing less.


    Actually, it made me chuckle first (none / 0) (#12)
    by andgarden on Wed Dec 16, 2009 at 08:13:15 AM EST
    But I still think it's sad.

    What made me chuckle (5.00 / 2) (#27)
    by Jackson Hunter on Wed Dec 16, 2009 at 09:38:09 AM EST
    was a diary by IBS of all people calling this bill what it is, an epic fail, and some just roasting her as a crybaby and a pony seeker (using PUMA defamations against one of the most ardent of Obama's followers.  She actually helps edit the "This Week with Barack Obama" love ode each week.)  I have to admit, I almost p*ssed my pants laughing so hard.

    Although there are some seriously strange, almost deranged lunatics over there.  People talking about how others aren't worthy of licking Barack's shoes and just showing a utter, religious faith in a person.  And yes, I notice the racism charge freely flies still.  

    That's why I don't post there, if someone told me I wasn't worth licking anybody's shoes I'd say something so evil that I have to troll rate myself into oblivion.  I'm with BTD, love your Issues, not your Pols.



    Sad (none / 0) (#13)
    by MO Blue on Wed Dec 16, 2009 at 08:14:33 AM EST
    Putting you in the Senate (none / 0) (#19)
    by Steve M on Wed Dec 16, 2009 at 08:58:17 AM EST
    would be like sending John Bolton to the UN!

    You've already used that one! (none / 0) (#20)
    by andgarden on Wed Dec 16, 2009 at 09:01:20 AM EST
    Like the Knicks trading for Stephon Marbury? (none / 0) (#24)
    by Steve M on Wed Dec 16, 2009 at 09:21:50 AM EST
    Sorry, sports ignorant here (none / 0) (#26)
    by andgarden on Wed Dec 16, 2009 at 09:23:35 AM EST
    The (5.00 / 2) (#25)
    by TeresaInSnow2 on Wed Dec 16, 2009 at 09:23:05 AM EST
    The "reasonable" yearly out of pocket maximums are a nice way to get around rescission and guaranteed issue, too.

    Yep, you're forced to insure everyone, but limit how much is covered for certain conditions....or limit how many doctors who cover certain conditions are in-network in your plan.

    Some might say, well these people will shop other plans! to which I say, there are many ways to collude....and 80% of insurees are on BC/BS.

    I think my final sticking point ... (5.00 / 2) (#29)
    by FreakyBeaky on Wed Dec 16, 2009 at 10:24:25 AM EST
    ... is mandates without a public alternative ("option" is so overused) - some kind of affordable, half-decent coverage if private coverage is too rich for one's blood - which it will be for some.  It's just plain wrong otherwise.  Take out the mandates and I could live with this non-bill we don't have yet, disappointing though it is.  

    I'm tempted to say take out the exchanges too, but that's just me wanting to take something away for Obama-Lieberman-Nelson and the rest of the rogues.  

    Mandates with no PO still just kill it for me - and I agree with Drum et. al. when I say that that we won't be revisiting health care for the forseeable future.  Or maybe at all.  I think it could end up going on the ash-heap of can't-do's with gun control.  Never underestimate the Gang of 100's ability to ignore a crisis.  

    I think Drum is right on this though-- (none / 0) (#1)
    by steviez314 on Wed Dec 16, 2009 at 07:08:23 AM EST
    if this bill fails, we will not be revisiting health care next year, or the year after, or for many years after that.  History clearly shows that.

    Otoh, I think if this bill passes, there will be opportunities to fix and add things, even through reconciliation, over the next few years.

    It may suck to be in this position, but that's where we are.

    What Digby .... (5.00 / 2) (#2)
    by trillian on Wed Dec 16, 2009 at 07:24:34 AM EST

    Sign anything? Check.
    Incompetent Democrats? Check.

    If this happens, we'll have a Republican bill that won't work, which no Republicans will vote for and which they will run against for the next decade at least.

    It's Newtie's wet dream.

    Opportunities? (none / 0) (#3)
    by Big Tent Democrat on Wed Dec 16, 2009 at 07:27:26 AM EST

    In this economic reality (none / 0) (#16)
    by Militarytracy on Wed Dec 16, 2009 at 08:29:23 AM EST
    That is ours for how many years now?  It is more unlikely that we can igore what is happening to people out there.  A very bad piece of legislation that will most likely make economic realities worse?  I would think that would be a larger worry.

    And worse still IMO (none / 0) (#17)
    by Militarytracy on Wed Dec 16, 2009 at 08:43:48 AM EST
    The insurance industry has now been invited to suicide itself.  It will remain wildly profit driven at a time when nobody can afford to survive longterm with such an attitude.  It doesn't matter if there are mandates or not, there will be no blood from turnips but lots of egg on faces with an internet system now that will record it all for posterity.  When the time comes to remember how we got here, the accountability will be easy to trace.

    Don't agree (none / 0) (#28)
    by gyrfalcon on Wed Dec 16, 2009 at 10:18:21 AM EST
    I think history shows us pretty much the exact opposite.  If this pile o' stuff passes, they may come back and tinker around the edges here and there (mostly in response to industry whining), but there will not be major revisions/improvements until the whle thing starts to implode completely many years from now.  And you better hope that there will be a Dem. pres. and Congress around to deal with it because the GOP would just end up canceling the whole deal and going back to where we are now.

    The circumstances with Clinton's health care reform attempt were entirely different from start to finish, most importantly in that there was no big head of steam for some kind of reform from all quarters then as there is today.


    The Insurance and pharma profit (none / 0) (#6)
    by MO Blue on Wed Dec 16, 2009 at 07:59:37 AM EST
    expansion bill will probably be made worse for consumers but this travesty will finally be passed so that Obama will have his historical moment.


    Yes, we must allow him (5.00 / 4) (#14)
    by Dr Molly on Wed Dec 16, 2009 at 08:15:43 AM EST
    a historical moment to claim credit for health care 'reform',

    just like his 'peace prize' for.....


    states (none / 0) (#7)
    by jedimom on Wed Dec 16, 2009 at 08:04:48 AM EST
    PS the states are looking to kill the Medicaid expansion since they cannot fund it

    PS Why does Bill Nelson get an exemption form Medicare Advantage cuts? his 3 districts in FL are promised not to get service cuts

    guess the rest of the elderly are on their own

    what a clusterfrak this has been

    Obama was the status quo candidate

    Top headline this morning: Medicaid cuts (none / 0) (#22)
    by Cream City on Wed Dec 16, 2009 at 09:03:59 AM EST
    in millions coming in my state, according to the leading paper in my state.  A state that has tried its own health insurance plan for the uninsured but no longer can afford it, because of the Obama "reforms."

    Conversely.... (none / 0) (#23)
    by kdog on Wed Dec 16, 2009 at 09:07:02 AM EST
    If "reform" passes, we're stuck with it for an even longer time...congress has not proven adept at rectifying mistakes in a timely manner...I mean shee-it we still have marijuana prohibition in effect for god's sake.

    Slight of hand by Silver? (none / 0) (#31)
    by MO Blue on Wed Dec 16, 2009 at 11:54:04 AM EST
    One caution: this reflects the situation before the public option was removed from the bill. But, provided that the subsidy schedule isn't changed as well, that shouldn't change these numbers much.

    Maybe Silver should wait and use REAL data to support his argument.