Hacker: Health Bill "A Step" Towards HCR

By Big Tent Democrat, Section Other Politics
Posted on Sun Dec 20, 2009 at 12:28:00 PM EST
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Jacob Hacker, the intellectual popularizer of the "public option" idea, argues that he "believes" in the Senate health bill as a step towards reform, yet argues:

If it does not deliver--if the new options offered through the exchange do not attract broad enrollment, if insurers continue to undermine health security with impunity--then the worst fears of progressives will come true. [. . .] And Americans will become increasingly disillusioned with the promise of reform.

[MORE . . .]

Progressives have good reason to be angry. Yet we should harness our anger to fix the bill--now and every year from now. The current bills in Congress do too little to help Americans immediately; their main actions are delayed for years. If and when legislation passes, progressives should demand immediate concrete actions to make the promise of a reform a reality more quickly and more effectively.

So a bill must pass. Yet it must be a better bill that passes. And it must be understood by the President, the Congress and every American as only a step--an important but ultimately incomplete step--toward the vital goal that the campaign for the public option embodied: good affordable health care for every American.

(Emphasis supplied.) The problem with this analysis is it does not really present a coherent POLITICAL argument for the next step. I have argued for sunsetting the mandates precisely because I do not see an impetus for a next step without such a provision. Hacker does not address that point. His piece strikes me as an unrealistic appraisal of the current bill and the prospects for real reform in the future.

Speaking for me only

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Hacker: Health Bill "A Step" Towards HCR | 60 comments (60 topical)

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I think you really have the right (5.00 / 2) (#1)
by andgarden on Sun Dec 20, 2009 at 12:29:44 PM EST

perspective on this. But as we know, Democrats are idiots at negotiation and political strategy.

i love those (5.00 / 6) (#16)
by Turkana on Sun Dec 20, 2009 at 01:02:52 PM EST

who excuse this bill by saying, in effect, i know it sucks but we can fix it later. because every step of the way, it's gotten worse, not better. and i'm still waiting for this congress to fix fisa and the "patriot" act.


"If you don't take the time to do it right... (5.00 / 6) (#21)
by goldberry on Sun Dec 20, 2009 at 01:06:55 PM EST

...when will you have the time to do it over?"


: when 'you' elect (5.00 / 3) (#36)
by oldpro on Sun Dec 20, 2009 at 01:30:31 PM EST

their replacements...

Totally agree (5.00 / 8) (#24)
by MO Blue on Sun Dec 20, 2009 at 01:08:09 PM EST

As I have stated in this thread and many times before, passing this legislation has a very good chance of not only delaying but actually making it harder to implement a good health care system in the future.


Not passing this legislation (none / 0) (#40)
by Politalkix on Sun Dec 20, 2009 at 02:07:58 PM EST

at this time may also open the path for a President Romney, President Pawlenty or President Daniels to pass the Republican version of HCR before the Democrats get another stab at implementing HCR legislation in the future. Republicans and Conservative Democrats can easily form a majority in the House and Senate beyond 2010.
If the liberals really want their ideas implemented in legislation, they should find a way to sell their ideas beyond 18 states. They should find a way to get Senators and Representatives who proudly campaign on a liberal platform to get elected from states that Al Gore and John Kerry did not win. Majorities in the House and Senate were obtained only after the Democratic Party fielded candidates who represented their states and districts better than what was done in the past, since the 2006 election cycle (thanks to Chuck Schumer and Rahm Emmanuel). Did Howard Dean really expect that after the Democratic Party won majorities through a 50 state strategy, legislation would be passed by adopting a 18 state strategy?


Foolish (5.00 / 1) (#49)
by Salo on Sun Dec 20, 2009 at 03:08:29 PM EST

The point is to weild power ruthlessly when you have it. This bill can be reversed in detail by any GOP admin. It's lethal politically and failed to reform structures of private profits.


So you want him to be the Democratic GWB (none / 0) (#53)
by Politalkix on Sun Dec 20, 2009 at 03:37:15 PM EST

Foolish of you, because we can see what happened to the Republican Party after GWB "weilded power ruthlessly".
HCR will not have any real impact politically. The bill will enable replacement of the present system with a better system, most people will see it that way.
The President should focus on fixing the economy and the war in Afghanistan now. More people are concerned about these issues than HCR.


How about the Democratic LBJ? (5.00 / 4) (#54)
by Big Tent Democrat on Sun Dec 20, 2009 at 04:00:50 PM EST

Or better yet, FDR?


: Nah, let Obama be Obama (none / 0) (#58)
by Politalkix on Sun Dec 20, 2009 at 08:37:18 PM EST

and let it be the jobs of historians to judge his impact on American history and politics after his term(s) get over.
For the time being let us just have consistent standards in judging Presidents.

What do you think is going to happen (none / 0) (#42)
by jbindc on Sun Dec 20, 2009 at 02:10:30 PM EST

is and when there is a President Romney/Pawlenty and a Republican majority?

And it will happen, probably much sooner than those hopey-changey folks believe.


This legislation is not popular (none / 0) (#51)
by MO Blue on Sun Dec 20, 2009 at 03:13:40 PM EST

so it could also open the path for a President Romney, President Pawlenty or President Daniels. The only difference will be that the Republicans will strip whatever few worthwhile items that still remain and keep and expand the worse provisions.


Amen to this. (none / 0) (#57)
by Anne on Sun Dec 20, 2009 at 08:21:37 PM EST

And I think you have articulated why it is that many of us have no confidence that a bill that has gone nowhere but downhill will somehow magically be able to be improved once it is passed.

It just won't.

Anyone who thinks it will is just kidding him- or herself.

Why we decided to start from mediocre instead of optimum is beyond me, but we aren't going to work our way to the best after rolling over and giving away all the good stuff.


: The Dems couldn't be BFF with the industries (none / 0) (#60)
by MO Blue on Sun Dec 20, 2009 at 09:00:47 PM EST

if they passed real reform that provided affordable health care.

As if they are going to touch this bill ever again (none / 0) (#59)
by suzieg on Sun Dec 20, 2009 at 08:41:22 PM EST

when 63% of the population is against it! They want it gone and forgotten!


Democrats Negotiate? (4.00 / 1) (#7)
by norris morris on Sun Dec 20, 2009 at 12:49:02 PM EST

In your dreams. Traditionally Democrats have lotsa trouble negotiating. Negotiating is a business art and skill backed up by a strong will ready to take risks.

The Democrats don't barter well, unless er, they use women's bodies to do it or find some other loathsome or cowardly giveaway. If they knew how to negotiate and had convictions the Nelson and Stupak add-ons would never exist. The Hyde law goes far enough in forbidding abortions with federal funds.

Our Democratic women Reps and Senators voted for Stupak ad Nelson's draconian hit on women's rights.. All of those in my voting district will be toast.

The sight of the current bartering,dodging,swapping, has been akin to a political orgy where everyone gets screwed. Even those that did not attend this orgy uh, like us.

Obama and team manipulated with concessions in backrooms from July on with their secret drug
giveaway to the drug monopoly. Obama's cold blooded and detatched absence was masterminded to let the drug and insurance monopolies take over provided they'd lay off negative ads against his "Faux Reform", and of course there's that election$$$$$ they need.

Obama has to now figure out how to get re-elected
with a huge propoganda machine blaring about HC merits. Since this cruddy bill doesn't start for around 4 yrs he's going to use this to con the public.

Fix this? With this bunch of Democrats who lack the ethics of a street prostitute? I don't think so.

I want my vote back.


About the drug industry... (5.00 / 0) (#19)
by goldberry on Sun Dec 20, 2009 at 01:05:14 PM EST

As a worker bee in that loathesome industry, I would like to defend it, but not the tactics taken. The industry has some real, legitimate issues to deal with that are leading to a crisis in the industry itself. I wish the industry had the courage to discuss these issues instead of taking the easy way out and doing deals in secret. They didn't do themselves any favors.
The US subsidizes the rest of the world's pharmaceutical needs. That's one of the reasons we pay so much here. The industry also has to service the stockholders. Thank the 401K system for tying greed to your pharmaceutical needs. And the research community is getting shipped to China and India. You can thank the patent system, class action lawsuits and a lackadaisical, political FDA for some of that too.
Remember that when you dump on big pharma, you're slitting the throats of all of the US researchers who work for it. We are getting laid off in droves these days while the people who arrange the mergers are humming all the way to the bank. Take the time to learn about our issues before you condemn us all to scientific oblivion.


I recently learned Upjohn no longer (none / 0) (#29)
by oculus on Sun Dec 20, 2009 at 01:16:30 PM EST

exists. Have to wonder how Kalamazoo is faring.


: Michigan in general (5.00 / 3) (#41)
by cal1942 on Sun Dec 20, 2009 at 02:09:09 PM EST

is not faring well. The unemployment rate in November was 14.7%. Probably the only reason it dropped from 15.2% is because a growing number of people are falling through the cracks.
People who support "free" trade should come here and see what those policies do to communities of actual people.
Michigan may well be the canary in the coal mine.

I put it in the comments in Franken's diary (none / 0) (#3)
by Militarytracy on Sun Dec 20, 2009 at 12:39:24 PM EST

at Orange, because it makes wonderful sense to me. It isn't something that anyone wants to talk about though, and I'm not sure that most understand how mandating 85% of every premium dollar to go to providing actual care leads us to cost containment.


franken's great (5.00 / 1) (#14)
by Turkana on Sun Dec 20, 2009 at 01:01:35 PM EST

but i'm not big on hit-and-run diaries by celebs and semi-celebs who don't bother to stick around and respond to comments. i'd have had some questions, if he'd been there to provide answers.


Always the voice of balance :) (5.00 / 1) (#17)
by Militarytracy on Sun Dec 20, 2009 at 01:03:27 PM EST

It's your forte.


heh (none / 0) (#20)
by Turkana on Sun Dec 20, 2009 at 01:05:44 PM EST

and in the past weeks, i've been accused of being everything, up to and including a racist.


: I know (5.00 / 2) (#25)
by Militarytracy on Sun Dec 20, 2009 at 01:10:47 PM EST

I've been reading you. I love you and TomP. The few, the proud, the fearless in the midst of flying cheetos or grumpy faces....depending on the diary and the day :) I love best the days when I show up to read and you guys are on the list, but nobody has a comment to make :)

Dems have discovered that this is a (5.00 / 1) (#28)
by MO Blue on Sun Dec 20, 2009 at 01:14:58 PM EST

good way to expand their mailing list. They should at least stick around and answer questions. Since a lot of the comments are devoted to memes of how thrilled people are by the celebs posting on the site, the time spent answering questions wouldn't be that great.


: Ugh, that makes me nauseous (5.00 / 1) (#31)
by Militarytracy on Sun Dec 20, 2009 at 01:20:20 PM EST

I just wasn't born sweet

It doesn't (5.00 / 2) (#50)
by lambert on Sun Dec 20, 2009 at 03:09:06 PM EST

because the rates aren't capped, and the regulation will be weak in any case.


I read (none / 0) (#11)
by TeresaInSnow2 on Sun Dec 20, 2009 at 12:56:57 PM EST

part of Franken's post and I couldn't get past "end the cap on ANNUAL limits" (paraphrasing).

At that point, I knew the rest would likely be riddled with "inaccuracies" and I closed the post.


So they didn't get that loophole fixed? (5.00 / 1) (#15)
by Militarytracy on Sun Dec 20, 2009 at 01:01:54 PM EST

I know that some have been working on it. I had hoped that it was fixed. If it isn't, then Franken is just trying to "sell it" to the roots. And that would be extremely disappointing.


Reminded (5.00 / 2) (#23)
by TeresaInSnow2 on Sun Dec 20, 2009 at 01:07:28 PM EST

me of the title of a book I once read, titled something like:

"Inaccuracies and the Inaccurating Inaccuraciers: A fair and balanced look at the right," by Al Franken.

Maybe that's not quite the title, but darned close.


Yer killin me (none / 0) (#26)
by Militarytracy on Sun Dec 20, 2009 at 01:11:43 PM EST

: Oh no! (5.00 / 1) (#55)
by TeresaInSnow2 on Sun Dec 20, 2009 at 04:20:47 PM EST

I'd better stop. The world doesn't have enough good ones like you!
ZIIIP!

Maybe step one... (none / 0) (#46)
by lambert on Sun Dec 20, 2009 at 03:07:25 PM EST

... should be to "harness our anger" to fix Jacob Hacker. Then we might get somewhere.


So what if (5.00 / 1) (#2)
by MO Blue on Sun Dec 20, 2009 at 12:39:19 PM EST

the new options offered through the exchange do not attract broad enrollment, if insurers continue to undermine health security with impunity, premiums continue to rise unabated while coverage continues to decline making the situation worse for people rather than better and Americans become increasingly disillusioned with the promise of reform, this lack of trust makes it more difficult to enact reforms in the future.

True (5.00 / 2) (#4)
by Big Tent Democrat on Sun Dec 20, 2009 at 12:40:15 PM EST

But to me, the more important part is the lack of the bargaining chip of the mandates in the future.


As I've said, I agree with you on (5.00 / 4) (#13)
by MO Blue on Sun Dec 20, 2009 at 12:59:37 PM EST

using the mandates as a bargaining chip. Yet, I'm really convinced that the current legislation is going off in the wrong direction in many ways and will not meet the objective of providing affordable health care. If it does not, it will be very unpopular once implemented. I'm not sure that tinkering around the edges will be enough to fix it. It also could very well make it a lot harder to get real reform in the future.

I don't think you can get affordable health care without a standardize system in place where all payers (insurers, doctors, hospitals) have to play by the same rules. The reforms that need to be made can be accomplished with a national government run system or through a highly regulated system like the Netherlands. Not with the hodge podge system that this legislation is enabling.


Mandates (5.00 / 1) (#27)
by cal1942 on Sun Dec 20, 2009 at 01:13:46 PM EST

won't be sunsetted because the HI industry want mandates to force people to buy.

The HI industry is running this show aided and abetted by the White House and Congressional leadership.

Those mandates may seriously damage the Democratic Party.


You make my point (none / 0) (#37)
by Big Tent Democrat on Sun Dec 20, 2009 at 01:30:59 PM EST

: Yes (5.00 / 1) (#39)
by cal1942 on Sun Dec 20, 2009 at 01:57:33 PM EST

but I don't think the Democratic leadership is smart enough to recognize that.

Mandates got tweaked yesterday (5.00 / 1) (#34)
by nycstray on Sun Dec 20, 2009 at 01:29:11 PM EST

Under the bill, most Americans would be required to have insurance. The penalty for violating this requirement could be as high as 2 percent of a taxpayer's household income. Penalties would total $15 billion over 10 years, up from $8 billion under Mr. Reid's original proposal, the Congressional Budget Office said.

NYT


: And when I read something like this (5.00 / 2) (#38)
by Militarytracy on Sun Dec 20, 2009 at 01:34:08 PM EST

I just throw my hands in the air

The discussion on the Senate floor is fascinating (5.00 / 1) (#8)
by andgarden on Sun Dec 20, 2009 at 12:53:29 PM EST

The Republicans are essentially coming at the bill from the left (i.e., Obama didn't keep his promises to cover everyone and reign in the drug companies). I think that's telling.

The soft spot is on the Left (5.00 / 2) (#10)
by Big Tent Democrat on Sun Dec 20, 2009 at 12:56:03 PM EST

The argument from the Right basically failed.


they can work him like a rag doll (5.00 / 1) (#18)
by Dadler on Sun Dec 20, 2009 at 01:03:40 PM EST

he's easier to use than crayons.


Yup (5.00 / 2) (#33)
by cal1942 on Sun Dec 20, 2009 at 01:24:27 PM EST

It's telling that the drug reimportation bill, opposed by the White House, was rejected by 31 of 60 members of the Democrtaic caucus and 17 of 40 Republicans.

Generally the GOP will appear to the left on that popular bill that was killed by Democrats.

The GOP Senators voting for the bill knew it would lose and knew that giving the bill the majority of their support could be used campaigning against Democrats.

Many Democrats will have big campaign war chests in the coming cycle but a fat lot of good it will do many of them.


Per Huff Post, Pres. Snowe says she (none / 0) (#9)
by oculus on Sun Dec 20, 2009 at 12:56:02 PM EST

can't support the bill because it happened too fast.

And Sen. Nelson (D-NE) says he doesn't welcome the spotlight.


It happened too fast? (none / 0) (#22)
by Militarytracy on Sun Dec 20, 2009 at 01:07:07 PM EST

Mother of God! Please smite her! She's only ticked that it happened without her. And Nelson, God be damned if you aren't primaried hard my man! Nebraska is hurting.....it is time to go a deeper shade of purple, less violet.


: Snowe is just doing her job (5.00 / 7) (#32)
by MO Blue on Sun Dec 20, 2009 at 01:21:08 PM EST

Her job always was to delay and weaken the Senate's bill and she never intended to vote for it. She should receive an A+ for meeting the Republicans objectives of killing the bill or making it so bad that everyone will hate it once it is implemented.

Divide & Conquer (none / 0) (#56)
by christinep on Sun Dec 20, 2009 at 04:35:54 PM EST

The Republicans are playing us off against one another. Recall the ole' circular firing squad. That is why the unification efforts of Sen. Harkin are so important. It is not about denying differences within the Democratic party; rather, it is about finding agreement on the things we can to move forward or, at least, recognizing that virtue here doesn't only belong to the progressive/liberal with whom you agree. When I was a kid, there used to be jokes about the Democrats' fights from within--its funny at a distance, but not up close. If we decide that we prefer Democrats to Republicans, we can't wait until October to think about that.


It also ignores the political reality (5.00 / 7) (#12)
by jbindc on Sun Dec 20, 2009 at 12:57:49 PM EST

That if they couldn't pass a better bill this year - when Obama had his (probably) highest popularity, and 60 votes in the Senate, then -it ain't gonna happen. Nothing will happen in 2010 ("we already fixed it", plus election year), chances are Dems lose seats, so they will be too timid to try anything else in 2011, then 2012 is a presidential election year, which means campaigning (but not governing) will start around Halloween, 2011.

Hacker is living in fantasy land.

Not.Gonna.Happen.

: Right (5.00 / 6) (#30)
by Pacific John on Sun Dec 20, 2009 at 01:18:45 PM EST

It's over for the balance of 4 or 8 years because as Obama showed during the stimulus process, he checks a box and moves on, even if it means 4 million unemployed people, and he appears to have drawn a line in the sand, that this is it: "I am not the first President to take up this cause, but I am determined to be the last," and by that, he clearly does not see this as a multi-year process, but as a single event.

This hope on mandates is too nuanced (5.00 / 6) (#35)
by Pacific John on Sun Dec 20, 2009 at 01:29:12 PM EST

and not likely to survive the conservative institutional campaign to make it radioactive. The most obvious attack is that the DP is forcing people to buy insurance that it doesn't want, need, or afford, but the GOP is capable of more insidious attacks than that.

There is nothing fundamental here worth building on. There is no muscular regulatory authority, no market device to drive down prices, no strategy to drive bad actors out of the market, no policy to strip paperwork and shell games from existing policies.

What we do have is a Rube Goldberg contraption (with a couple of cool gears or links) that will be impossible to refine into something elegant.

Sorry for the double, BTD + TLers (5.00 / 1) (#45)
by Ellie on Sun Dec 20, 2009 at 02:18:15 PM EST

Delete (or troll rate me as a clutterbuck) with extreme prejudice. :-)

I just gave you a 5 (none / 0) (#47)
by TeresaInSnow2 on Sun Dec 20, 2009 at 03:07:35 PM EST

for making ME not look like quite as much of a dork for all of my editing oversights.


: Thanks! (I think ...) :-D n/t (none / 0) (#52)
by Ellie on Sun Dec 20, 2009 at 03:34:05 PM EST

Hacker's comments (none / 0) (#5)
by christinep on Sun Dec 20, 2009 at 12:46:59 PM EST

Jacob Hacker, from a political philosophy perspective, states the repositioning and goal approach well (ala Senator Harkin.) Yet, it does need something more in the way of strategy. I think, BTD, that your comments about the "mandates as bargaining chip" provide the strategic action that nicely supplements Hacker's very general goal-oriented comments.

: I have a specific proposal (none / 0) (#6)
by Big Tent Democrat on Sun Dec 20, 2009 at 12:48:47 PM EST

Sunsetting the mandates.
If that is added, it seems to me the bill should be supported.

Foreseeable 'Disillusionment' less a problem (none / 0) (#43)
by Ellie on Sun Dec 20, 2009 at 02:11:55 PM EST

... than what can be fixed now.

Disillusionment is an abstract emotive weather forecast.

Depriving huge sections of the population of rights and services that are currently legal, and commonly accessed, however, flies in the considerable record of quantifiables that have been thoroughly measured and studied.

There's simply no reason for government, politicians or corporate predators -- all of whom will get a big sloppy piece of this pie immediately -- to improve this bill afterwards.

They'll more likely use the time after passage to reward themselves further.

Foreseeable 'Disillusionment' less a problem (none / 0) (#44)
by Ellie on Sun Dec 20, 2009 at 02:11:56 PM EST

Shorter Hacker (none / 0) (#48)
by lambert on Sun Dec 20, 2009 at 03:08:17 PM EST

"I need continued funding."