Senate Passes Health Care Bill, 60 to 39

It's done. Obmama can drink a glass of champagne on the flight to Hawaii and members of the Senate can fly home for Christmas with puffed- out chest bragging they did it, they outmaneuvered the Republicans and garnered 60 votes to pass historic health care legislation.

The fight, which will be mostly for show, will move to the House after Jan. 1, when a conference is held and the House capitulates on the reforms that might have really made the bill historic.

The bill will help some people but not enough. It will be too expensive for many, and many of its benefits will still be years away. [More...]

I hope Obama, on his return, turns his attention to some of the other campaign promises he made, particularly on criminal justice issues, because if he doesn't, and the Dems get booted out of their majority status in 2010 because of this turkey of a health care bill which has turned into something reminiscent of The Emporer With No Clothes, we're never going to get them.

For those progressives who think Obama sold them out on health care, he didn't. He gave you exactly what he promised: centrist, moderate action formed by compromise, designed to unite the red and blue stripes of America. ("There are no red states, there are no blue states, there is only the United States....") That's what he ran on and that's what he delivered. Any specific promises he made were always going to be subject to and at the mercy of this larger, over-all theme.

Happy holidays, and if you are one of the many Americans who are healthy, insured and happy with your current health plan, start stuffing your piggy bank.

You're going to need extra money in the years to come to cover increased premiums and out of pocket expenses as your health insurance company comes up with creative ways to pass the excise tax and other increased costs in this bill on to you or your employer, at the same time it reduces the benefits in your existing plan of choice. And guard your health, so you don't need novel or experimental procedures, or third or fourth opinions or tests, because they probably won't be covered any more.

It's a good thing that many sick and poor people currently without insurance will be able to get it and more children will be covered. But ultimately, it's the rest of us, not the Government or the insurance companies or doctors, who will be picking up the tab. It's change, just not quite the kind many hoped for.

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    This is simply not true (5.00 / 3) (#1)
    by Big Tent Democrat on Thu Dec 24, 2009 at 11:09:36 AM EST
    "He gave you exactly what he promised"

    That he gave us what a reasonable observer should have expected from him is a different point.

    But what you wrote is inaccurate.

    I think it is true (5.00 / 1) (#3)
    by Jeralyn on Thu Dec 24, 2009 at 11:12:43 AM EST
    if you listened between the lines of his campaign rhetoric, as I did. So we'll have to disagree on this.

    Again (none / 0) (#5)
    by Big Tent Democrat on Thu Dec 24, 2009 at 11:14:31 AM EST
    that is not the same thing as what you wrote.

    He did not "promise" what you say he promised.

    That a reasonable observer should have known that, like all pols, Obama was going to break his promises on health care (and other issues) is not the same thing as saying, as you do, that he did not break his promises.


    Sorry, he promised compromise (5.00 / 2) (#7)
    by Jeralyn on Thu Dec 24, 2009 at 11:17:49 AM EST
    with Republicans in the name of bi-partisanship and that's what he delivered. And it matters to me because I repeatedly objected to that during his candidacy. So you can write your own post saying he abandoned his specific promises on health care, but to me they were always subject to him compromising his specific promises in favor of his greater adherence to his overall promise of compromise.

    Yep. WORP. What Obama Really Promised. (5.00 / 2) (#13)
    by Dan the Man on Thu Dec 24, 2009 at 11:28:28 AM EST
    He promised (none / 0) (#9)
    by Big Tent Democrat on Thu Dec 24, 2009 at 11:21:05 AM EST
    on health care reform, certain specific changes.

    Look, this has been a discussion for the past few days. I think you are discussing this in different terms and I think, misstating the point.

    If you had written what you wrote in a different context, I would not be dissenting. But writing in the wake of the discussion of whether Obama campaign on the public option, I think your statement is not correct.


    You are missing my point (none / 0) (#14)
    by Jeralyn on Thu Dec 24, 2009 at 11:28:45 AM EST
    and mis-stating it. My post, with the added sentence, stands. I'm not referring to details like the public option. His stood by his greater general promise of compromise and working with
    Republicans. That's my take-away from all this and you need to write your own post if you'd like because you are muddying mine.

    The context of your post (none / 0) (#20)
    by Big Tent Democrat on Thu Dec 24, 2009 at 11:46:56 AM EST
    is what creates the confusion imo.

    The last few days have focused a good deal on the specific promises Obama made on health care.

    When you write, in the context of the passage of the health bill, that Obama kept his promises, I think you are misstating the facts.

    But we have hashed this out as far as we can.


    I like churchill's promise. (none / 0) (#46)
    by Salo on Thu Dec 24, 2009 at 01:42:29 PM EST
    "I have nothing to offer but Blood, Sweat and Tears."

    Now that guy was a wordsmith.


    For the record (none / 0) (#10)
    by Big Tent Democrat on Thu Dec 24, 2009 at 11:22:25 AM EST
    I already wrote that post. It was the center of discussion for the past few days.

    Sort of why it is important to keep the record straight. I think your assertion muddies the issues.


    I added the sentence (5.00 / 1) (#11)
    by Jeralyn on Thu Dec 24, 2009 at 11:25:38 AM EST
    "Any specific promises he made were always going to be subject to and at the mercy of this larger, over-all theme." I've been making this point since 2007 and intend to keep making it. Health care is just one topic it will apply to.

    Cool (none / 0) (#16)
    by Big Tent Democrat on Thu Dec 24, 2009 at 11:37:04 AM EST
    glad we resolved it! (none / 0) (#34)
    by Jeralyn on Thu Dec 24, 2009 at 12:51:32 PM EST
    thanks, I hate when you're upset.

    The Dems delivered (5.00 / 1) (#54)
    by domer5000 on Thu Dec 24, 2009 at 03:01:18 PM EST
    what they were politically capable of delivering, without a vote to spare.  Hopefully, if will be the framework of something better over time.

    Don't hold your breath (5.00 / 2) (#70)
    by cal1942 on Thu Dec 24, 2009 at 05:54:05 PM EST
    But isn't it true (5.00 / 2) (#4)
    by Cream City on Thu Dec 24, 2009 at 11:14:16 AM EST
    that Obama gave what he promised sometimes, but not what he promised other times?

    That's the way he was on just about everything in the campaign.  Great job skills for a Commander in Chief, or what the military calls CYA.


    A matter of emphasis (none / 0) (#62)
    by christinep on Thu Dec 24, 2009 at 05:28:13 PM EST
    What I remember about the latter days of the campaign for President and the early days of the healthcare campaign was that President Obama stressed or emphasized different things/components at different times. Of course, that eased one into hearing what one wanted to hear. Jeralyn makes a good point--the total context of the broad outreach (I particularly remember the almost-tribute to Reagan in the Nevada primary)suggested a centrist Democrat. (But, as you might know, there are some good things in the forming legislation in that a lot is gained; and, not-so-good outcomes, in that what many healthcare reform advocates had hoped for in cost containment/competition is not there yet.)

    In other words, (5.00 / 3) (#37)
    by Spamlet on Thu Dec 24, 2009 at 12:57:09 PM EST
    don't believe a word Obama says, if you want to be deemed a reasonably reasonable observer. Check.

    Don't believe what ANY pol says (5.00 / 1) (#48)
    by Big Tent Democrat on Thu Dec 24, 2009 at 01:51:24 PM EST
    The history of what they've actually done (5.00 / 2) (#65)
    by shoephone on Thu Dec 24, 2009 at 05:42:54 PM EST
    tells us whether what they say in the future can be considered at all credible.

    Obama's pretty words never matched his past ugly actions. Allowing himself to be bought by Exelon Corporation, and his lies about fillibustering the FISA bill were all I needed to know about him.

    Some pols are much, much worse than others. Sad to know, some of the worst are in the party I used to support.


    Yes (5.00 / 2) (#73)
    by otherlisa on Thu Dec 24, 2009 at 06:14:27 PM EST
    I don't think "pols are pols" really covers this situation. Some are much worse than others. And it's not unreasonable or naive to expect them to fulfill mandates from their constituents.

    I do tend to agree with Jeralyn here: I knew this was the kind of "reform" we were going to get from Obama. Everything he has done has been completely predictable to those who paid attention to his political career.

    He is not an ideologue, which is good. But he also holds no particular policy positions, which isn't, and his goals are entirely about being able to proclaim "victory" regardless of what the battle actually accomplishes.

    He's Robert Redford in "The Candidate." A hollow man, essentially.

    Merry Freakin' Christmas, America. Thanks for the hope n' change.


    I wouldn't buy a used car from the man (5.00 / 1) (#78)
    by Cream City on Fri Dec 25, 2009 at 12:39:49 AM EST
    so I sure don't buy anything else he says, with his record of saying anything that will help him win.  Or, heck, saying anything Hillary just said that will help him win.

    Trying To Make It Our Fault?? (none / 0) (#84)
    by norris morris on Fri Dec 25, 2009 at 08:52:40 PM EST
    Obama made many specific promises both in debates, on the campaign trail, and posted on his website.

     The donations sought and given were based on the promises posted on his website.

    Both Obama and his WH propoganda are making Obama's FAILURE to meet his own goals OUR fault?

    In other words believing him was our fault because we overexpected and were delusional?

    This is the lowest kind of denial possible and refutes the plain facts.  I would expect this crap from Karl Rove.

    But then I see there's David Axelrod and Rham.

    Obama's denial is a strong indication of the direction he's going in as he says he's not a liberal and never claimed to one.

    So we  who voted for him are imagining what we thought he was, and imagined what he really promised?  I guess we're stupid foolish dreamers and of course he indicates he owes us nothing. We're just lefty trash who don't matter.

    That's a lot of people who won't be voting for him or his congress at voting time.


    For those of us of a certain age (5.00 / 3) (#6)
    by Cream City on Thu Dec 24, 2009 at 11:16:21 AM EST
    Jeralyn, as we are the same age -- I agree.  We are the ones really getting whomped by this bill, and by this economy, at the worst time for it in our lives.  See you in non-retirement for a long time to come . . . and of course, that also doesn't help those younger than us who want our jobs.  We're not going anywhere, any time soon.

    the best thing about our age is (5.00 / 1) (#8)
    by Jeralyn on Thu Dec 24, 2009 at 11:20:17 AM EST
    we only to pay five years of increased premiums for lesser coverage until Medicare eligibility -- provided there still is a valuable Medicare then.

    Yes. But I catch the skepticism (5.00 / 4) (#17)
    by Cream City on Thu Dec 24, 2009 at 11:39:50 AM EST
    from you, too, as to what remnants of Medicare may be left for us.  And we also get to worry about what else the faux Gen X'er (but actual boomer, much as he tries to evade that) will do to our so-called "entitlement," old-age insurance for which we have been paying for almost half a century now (I started paying at age 15), Social Security.

    I started at 16 iirc (5.00 / 5) (#19)
    by nycstray on Thu Dec 24, 2009 at 11:45:02 AM EST
    and am very nervous about SS and MC under Obama. Looking forward (NOT!) to going broke on premiums before they kick in, if they are still in existence in a useful form that is . . .

    I also started paying at 16 (5.00 / 6) (#28)
    by MO Blue on Thu Dec 24, 2009 at 12:18:14 PM EST
    Since I'm now 65, I hope I can receive current benefits for a couple of more years.

    I too am very nervous about SS and MC under Obama. I have a limited income and a preexisting condition with a high recurrence rate. Access to health care is very necessary. Reductions in either program would put me in a very precarious position. Since I have assets (house) and some savings, I would not be eligible for any assistance and I would be put in the position of worrying whether my savings would expire before I do.


    Never thought I would be worring about this (5.00 / 6) (#36)
    by nycstray on Thu Dec 24, 2009 at 12:56:40 PM EST
    with a Dem prez and majority.

    I started worrying about this (5.00 / 3) (#39)
    by Spamlet on Thu Dec 24, 2009 at 01:13:11 PM EST
    in the late winter and spring of 2008.

    During the primary and the run up (5.00 / 5) (#40)
    by MO Blue on Thu Dec 24, 2009 at 01:13:34 PM EST
    to the general, I opined that Obama would accomplish what the Republicans had failed to do for decades. I am still of that opinion.

    The best way to eventually eliminate extremely popular social programs is to gradually make them less workable and less popular. Reduced benefits and limited access to care for Medicare patients, for example, would accomplish that.  


    We Have Become Vulnerable (none / 0) (#85)
    by norris morris on Fri Dec 25, 2009 at 09:06:58 PM EST
    By a Democrat who promised change, better addordable healthcare, a public option, and to changing the atmospheric negativity in DC, strong positions on climate change, justice for gays in the military, and more and more.

    Because Obama has clearly misrepresented himeslf and has subjected himself and us to his backroom politics and deals with lobbyists, and we have a highly compromised bill that may never even take place.

    By 2014 when most stuff supposedly kicks in, the Republicans will be back if Obama continues these positions, and the HC bill will be up for serious recission.

    Most of us are more vulnerable because of Obama than we were before.  He has put millions of us in jeopardy. Women will be subjected to hideously unfair restrictions on their right to choose.

    There is reason to worry.


    Ah, but "fixes" to Medicare (5.00 / 1) (#18)
    by MO Blue on Thu Dec 24, 2009 at 11:43:50 AM EST
    are included in the bill. The CBO is unclear what the effect will be.

    Based on the longer-term extrapolation, CBO expects that inflation-adjusted Medicare spending per beneficiary would increase at an average annual rate of less than 2 percent during the next two decades under the legislation--about half of the roughly 4 percent annual growth rate of the past two decades. It is unclear whether such a reduction in the growth rate could be achieved, and if so, whether it would be accomplished through greater efficiencies in the delivery of health care or would reduce access to care or diminish the quality of care. CBO

    It also reduces the Medicare Disproportionate Share Payments.

    Most agree that DSH funds preserve access to care for Medicare and low-income populations by financially assisting the hospitals they use. link

    It, also, sets up an Independent Medicare Advisory Boards whose recommendations for changes to Medicare will become law without amendment or change unless overridden by Congress. This makes the board not individuals members of Congress responsible for any changes that negatively effect people on Medicare.


    The promise Obama neither made or broke: (none / 0) (#23)
    by KeysDan on Thu Dec 24, 2009 at 11:58:07 AM EST
    Medicare is going to pay for about half of the health care reform--where did that come from anyway?

    He did say that Social Security was on (5.00 / 3) (#29)
    by MO Blue on Thu Dec 24, 2009 at 12:20:49 PM EST
    the table. I have read in several places that it is next on his agenda of "fixes" to entitlement programs.

    Well, as long as "fixes" (none / 0) (#31)
    by KeysDan on Thu Dec 24, 2009 at 12:32:16 PM EST
    are on the table, and not "reform", we will be better off.:)  Happy Holidays to you and all.  d

    A B+?? (none / 0) (#86)
    by norris morris on Fri Dec 25, 2009 at 09:37:12 PM EST
    I  believe Obama's grading his performance as a B+ is another example of his conceit and absence from reality and connectiveness.

    He has failed outstandingly. Wall Street got bailed out without a penny of interest paid back to our Treasury.   The same bunch that were part of our financial bust  are now in the White House guiding Obama to protect them, which he has.No one knows what exactly Bernanke has done with our money.

    Last week Obama invited the big 3 Wall St giants, Morgan/Chase,Citibank, and Goldman Sachs to his "Financial Summit" in DC.

    Guess what? They were no shows as they said the weather [fog] in DC was a "problem" and didn't attend.  Obama dissembled on TV and spoke to them from his pulpit mouthing lackluster and specious generalties too embarrassing to listen to. Wall Street told him to shove off.  Because they know they can.  This was as faux a summit as much  is in his WHouse these days.

    So considering his submission to drug and insurance lobbyists and cartels, denying he ever wanted a public option, being  silent for months
    in engaging about HCare,denying change for gays in military, failing to accomplish anything in Copenhagen [and bragging on it's success],ramping up our military incursion in afghanistan, and being unconcerned about the end run on RoevWade by putting women's right to choose and their rights to equal protection, and finally the coup of giving Leiberman and Nelson the right to trash an already compromised healthcare bill.

    He has not listened to those who voted for him and his arrogant manner of ruling was a surprise after his passionate rhetoric while campaigning.

    Wall Street has no regulation and our credit card interest went up to 30% after his credit card speech. Banks are not lending money and mortgage relief is a stalled and incompetent mess.

    Next will be a huge bailout to failed and corrupt Fannie and Freddie largely responsible for mortgage failures. Yeah, Rham was advisor on Board.

    So Obama has the stones to give himself a B+?


    Take a look at the Bushian Medicare Advantage (none / 0) (#63)
    by christinep on Thu Dec 24, 2009 at 05:35:36 PM EST
    Obama is good because (5.00 / 2) (#66)
    by shoephone on Thu Dec 24, 2009 at 05:44:26 PM EST
    Bush was so bad.

    Got it.


    Actually... (none / 0) (#67)
    by christinep on Thu Dec 24, 2009 at 05:50:07 PM EST
    and, my point was in response to a question about where the "Medicare cuts" originate. (I didn't mean to imply that "Bush was bad here, so Obama gets to be bad there." On the other hand, it helps to remind ourselves about the context for 2009 in terms of the clean-up we all have had to do from those not-so-halcyon days of Jan 2001 to Jan 2009.

    I am not clear on your correlation between (5.00 / 2) (#74)
    by KeysDan on Thu Dec 24, 2009 at 06:22:34 PM EST
     Medicare Advantage and the question of Medicare bearing so much of the freight for financing the extension to those under 65.  Certainly "savings" could be derived from eliminating the Medicare Advantage program, but that will not occur under the bill, in my view (it hasn't so far, cf. Senator Bill Nelson, D. Fl).  The "savings" or, more accurately, cuts, are coming from other places.  Indeed, the "spending more and achieving less" argument by assertion, and one that President Obama uses, including reduction of  excessive lab tests, is based on the administration's health economist's bible of the Dartmouth study, which measures inputs and outputs, but has recently been observed to be based on an oddity".  These researchers only followed the effects of treatment on those who died (not really a desirable outcome); it did not include the effect on those who lived. oops.

    The most that Medicare Advantage prior to (none / 0) (#90)
    by MO Blue on Sat Dec 26, 2009 at 02:21:55 PM EST
    allowing Florida residents to maintain their plans was $118 b per the CBO report. That leaves almost $400 billion in cuts to the program over and above the so called Medicare Advantage saves.

    Bush's Medicare Advantage? (none / 0) (#87)
    by norris morris on Fri Dec 25, 2009 at 09:51:08 PM EST
    For openers the Democrats helped Bush do it, and some of it isn't as bad as what's coming ala Obama.

    Democrats voted to give Bush his tax cut advataging the wealthy, Iraq, and Medicare D RXPlan with its donut hole. Ans other scams.

    The holes in the current Senate monstrosity are the result of Nelson,Leiberman, and Obama's rush to get ANYTHING, and dealing secretly and ruthlessly with BigPharma and Insurance lobbyists and their cartel.  He has not offered leadership and his feeble attempts at hoodwinking us about Healthcare are over.

    Stop blaming Bush. Obama was elected to change,correct, and deal with us openly to advance the ideas he kept telling us about. Remember?


    turning 55 this month sucked (5.00 / 2) (#33)
    by kempis on Thu Dec 24, 2009 at 12:36:31 PM EST
    What could have been....I have a special personal dislike of Lieberman and Obama now.

    As you say... (none / 0) (#15)
    by desertswine on Thu Dec 24, 2009 at 11:34:47 AM EST
    "guard your health."

    Purple (5.00 / 2) (#12)
    by NealB on Thu Dec 24, 2009 at 11:27:11 AM EST
    The color of a bruise; the color of royalty. Obama promised purple, the voters voted for purple, and purple is what we're getting.

    It's one thing to say that his (5.00 / 5) (#21)
    by Anne on Thu Dec 24, 2009 at 11:52:36 AM EST
    specific promises were always going to be subject to change, but he was specific.  Obama has not been, and apparently cannot be, honest about what those specifics were because it might lead people to question (1) what happened to those positions, and (2) why didn't he fight for them?

    And, it's all well and good to be centrist and bipartisan, but there still have to be principles at the core, things that are deal-breakers.  There was a remarkable and deafening silence from Obama in the area of women's health; he chose to be a mere spectator in an area that I, at least, think required some leadership.  If he could twist arms and threaten members of Congress if they did not get on board and pass his war funding bill, one can only conclude that Obama did not get involved in this area because he agreed with it.  Agreed that women could be thrown under the bus, agreed that the public option was unnecessary, agreed that reform could wait for another four years, agreed that we should not reimport drugs from Canada - not right now.  Agreed, agreed, agreed.

    I think what we may discover is that "purple" is the color of apoplexy.

    This pattern of behavior does not bode well for anything else he said he wanted to do - I think what we've seen of Obama on health care is the template for all the other issues that cannot be solved via executive orders.

    Yes, purple is generally not a healthy (5.00 / 1) (#24)
    by KeysDan on Thu Dec 24, 2009 at 12:00:51 PM EST
    color--it beckons care.

    Position on women & (5.00 / 1) (#56)
    by BackFromOhio on Thu Dec 24, 2009 at 03:26:56 PM EST
    the health bill reminiscent of his stance on abortion and whether threat to a woman's mental health should be grounds for late-term abortion.

    Anne- A Great Post (none / 0) (#88)
    by norris morris on Fri Dec 25, 2009 at 09:57:42 PM EST
    Thanks for your post. Yes Obama is backtracking and has betrayed what he and we believed were his core values.

    Women will suffer brutally re: the abortion provisions. Only well off and connected women will be able to exercise freedom of choice. And having spent decades fighting for women's rights the irony of this end run against RoevWade is obscene and disheartening.

    Women will have to start anew in fighting for their rights to equal protection.


    I doubt (5.00 / 3) (#22)
    by jbindc on Thu Dec 24, 2009 at 11:54:29 AM EST
    Criminal Justice matters will be in his top ten things to focus on.  He has to focus on jobs, and the economy, then of course, his Super Bowl and March Madness picks, another Valentine's date night, the WH Easter Egg Roll, vacation during Easter break, a token nod to Afghanistan and foreign policy, fundraising for 2010 elections, and then maybe criminal justice.

    Shee-it..... (5.00 / 1) (#30)
    by kdog on Thu Dec 24, 2009 at 12:28:14 PM EST
    we probably only get a year of focus out of him period, then its all 2012 re-election campaign all the time.

    I said when he was elected......... (5.00 / 2) (#42)
    by jimakaPPJ on Thu Dec 24, 2009 at 01:35:01 PM EST
    Success is getting what you want.

    Happiness is wanting what you get.


    heh (none / 0) (#82)
    by jimakaPPJ on Fri Dec 25, 2009 at 02:16:39 PM EST
    Re-election started the day he took office. (5.00 / 2) (#58)
    by rennies on Thu Dec 24, 2009 at 03:37:52 PM EST
    As per Glenn Greenwald, the Health"Reform" Bill is all about capturing corporate money for 2012.

    That's usually the electoral timetable (none / 0) (#64)
    by christinep on Thu Dec 24, 2009 at 05:40:41 PM EST
    And, that is why the passage of any legislation of the complicated, controversial, significant healthcare variety would occur early in the Presidential cycle or not at all.  (That, for me, was all I needed to go with what you can get now as a foundation or risk nothing as the inevitable political machinery starts to turn to the next election--and, during the election cycle, political history shows not much happens in the way of major legislation.)

    He already backed the AG off of Med. Marijuana (none / 0) (#68)
    by Socraticsilence on Thu Dec 24, 2009 at 05:50:58 PM EST
    prosecutions- that's a decent start.

    Well my way of working around this (5.00 / 7) (#25)
    by TeresaInSnow2 on Thu Dec 24, 2009 at 12:04:26 PM EST
    is that as soon as the plan is in place, if I'm still on the individual market, I'm dropping my insurance and paying the tax.  The tax would currently be a quarter of my health insurance costs and way les than that once Obama's glorious policy kicks in.

    If I get seriously ill, the pre-existing conditions waiver is going to help me buy insurance (RIIIGHT?).  So I'll just buy the insurance when it's needed.

    If I have an emergency like a heart attack, I'll just file bankruptcy.  Fvck them.  Fvck everyone who supported this crap.

    At present, I carry high enough deductible insurance that I pay most of my medical care out of pocket.  When I drop insurance, I'll pay all of it.  And again, barring extreme sickness, it'll be cheaper to do this than it is now to carry insurance, and definitely less expensive once we're getting even further railroaded by insurance via Obama's bill.

    And the moment Obama signs this bill I vow NEVER to vote for a Democrat again.  Because guess what? Democrats are NOT better than Republicans.  Maybe they once were, not now.  I'm glad Jane at FireDogLake has figured that out well enough that she's actually working with Grover Norquist.  People at DailyKOS are screaming about that.  But maybe they'll someday figure out that Obama no more has our interests at heart than Norquist does.  And anything that kills this bill no matter who you have to work with to do it, is a good thing.

    I hope there will be riots on the street.  I will join them.

    is too low-- it basically lets people get a great deal if they're willing to free ride-- 2% of income in penalty then get insurance when sick.

    Yeah, such a great deal (5.00 / 1) (#75)
    by shoephone on Thu Dec 24, 2009 at 08:44:07 PM EST
    To live without insurance, get punished by the IRS, and have to pay out of pocket for all your medical expenses.

    On the other hand, there's that new shiny Obama program to force us to buy unaffordable junk insurance, so's we kin make the industry even richer!

    What to do, what to do.


    Thanks for the tip (none / 0) (#32)
    by NealB on Thu Dec 24, 2009 at 12:36:20 PM EST
    I'm right there with you for more selfish reasons. But, as you say, fvck them.

    careful (none / 0) (#91)
    by jedimom on Sat Dec 26, 2009 at 02:24:21 PM EST
    the Senate highlight sheet seems to indciate there is NO CAP on the amount of premiums that people with pre ex conditions can be charged for some period of time...

    it may be cheaper for some to keep a bare bones high ded min benefit plan in place avoid a pre ex kicking in, thus their premiums stay low until this oeriod where they could theoretically charge a person with lets say daibetes who enrolls 8 x higher than anyone else...

    then after that period ends I am thinking people will doe xactly what you outline..


    I'm not even condfident... (5.00 / 3) (#26)
    by kdog on Thu Dec 24, 2009 at 12:07:31 PM EST
    it will help the poor in my state...per usual who knows who or what to believe but when I hear the bill means clinics closing instead of new ones opening I gotta wonder how that helps the poor of NY.  When I hear the state has to come up with a new billion at some point, when we can't even come up with money to maintain the long-standing policy of free mass transit for school kids...I gotta wonder how that helps the poor.

    Get a grip (none / 0) (#38)
    by Spamlet on Thu Dec 24, 2009 at 01:11:19 PM EST
    If you were a reasonable observer, kdog, then you would know that this bill is intended to help the truly needy, that is, the insurance industry titans in their welfare BMWs.

    They will upgrade to custom designed Rolls (none / 0) (#41)
    by MO Blue on Thu Dec 24, 2009 at 01:15:08 PM EST
    after this goes into effect.

    Obama today (5.00 / 4) (#27)
    by robotalk on Thu Dec 24, 2009 at 12:10:22 PM EST
    calls this a great victory against special interests, namely the insurance companies.

    So, you see, Obama likes to have it both ways.  He uses flowery progressive rhetoric even when the "change" achieved is actually strictly compromise and may well be regressive, not progressive.  Whatever else may be said, this is insurance company welfare if nothing else.

    I, for one, don't appreciate Obama's deployment of progressive rhetoric, which is just so much manipulation, which is just another form of lying, IMHO.

    Against special interests?! (5.00 / 1) (#35)
    by nycstray on Thu Dec 24, 2009 at 12:53:51 PM EST
    Is he nuts?! Even people not paying that close of attention can see the big give here.

    The difference is (none / 0) (#57)
    by BackFromOhio on Thu Dec 24, 2009 at 03:31:51 PM EST
    that the public does not believe him any more. Look at the polls....
    And, even the MSM pundits who supported him tooth & nail during the primaries & the election season are questioning him.  Lawrence O'Donnell did quite a number on Obama's flip flops on health care etc. last night when he hosted Olbermann.

    Obama {hearts} Reagan (5.00 / 2) (#43)
    by ding7777 on Thu Dec 24, 2009 at 01:35:40 PM EST
    and he told us so...

    Reagan was a transformative political figure because he was able to get Democrats to vote against their economic interests to form a majority to push through their agenda

    Apart from BTD point of order... (5.00 / 1) (#45)
    by Salo on Thu Dec 24, 2009 at 01:39:42 PM EST
    ...good diary.

    yet I tend to think it's very hard to understand anything that obama States.

    Look at teh absurdity of the Nobel prize Speech/Venue/Afghan context.

    Look at his attacks on Mandates in the primary wars.

    The guy's a gifted opportunist and not much more.

    Lets see (none / 0) (#72)
    by Socraticsilence on Thu Dec 24, 2009 at 05:55:48 PM EST
    the Nobel speech outlined the moral necessity of some war- an accepted part of virtually every major moral doctrine, he campaigned against Mandates because they were then and remain now- politically disasterous (while being economically necessary in a guareteed issuance system), and as BTD says- all pols will spin an issue to make themselves look good.

    It was an absurd speech (none / 0) (#77)
    by Salo on Thu Dec 24, 2009 at 09:23:44 PM EST
    In the context of the venue and indeed the prize. Afghanistan is long passed justification for active combat operations. Long long passed.  Mandates are no problem if there's a public plan.

    When I;m elected, everyone will get (5.00 / 2) (#71)
    by Ben Masel on Thu Dec 24, 2009 at 05:54:43 PM EST
    the same Hawaiian vacation The President enjoys.

    heh (none / 0) (#76)
    by andgarden on Thu Dec 24, 2009 at 08:57:08 PM EST
    Tiberius returns to Capri (none / 0) (#44)
    by Salo on Thu Dec 24, 2009 at 01:37:46 PM EST
    What a viper he places in the bosom of Rome.

    Premium cost calculator (none / 0) (#49)
    by gyrfalcon on Thu Dec 24, 2009 at 01:59:29 PM EST
    by Kaiser foundation here.

    You can see different results for policies purchased through the "exchange" for House and Senate bills as they now stand.

    Pretty interesting.  I note that both bills come out with lower premiums (including subsidies) for me than the very good VT system.

    What it doesn't/can't say, of course, is what kind of policy it will be, deductibles, co-pays, etc.

    Oops (none / 0) (#50)
    by gyrfalcon on Thu Dec 24, 2009 at 02:00:16 PM EST
    well (5.00 / 1) (#51)
    by nycstray on Thu Dec 24, 2009 at 02:21:23 PM EST
    a 55 yo person @48,000 (picked a number a bit above subsidy level) would have to pay 6,607 per year or 550 per month. They get charged at 1.89 because of age and it is 13.8% of their income. I thought Axe said we wouldn't pay more than 8%?

    That "penalty" @ 2% is looking good . . .


    Good question. (5.00 / 1) (#53)
    by gyrfalcon on Thu Dec 24, 2009 at 02:40:56 PM EST
    I have no idea what the answer is, except maybe that Axelrod is talking through his hat.  His boss does, so why shouldn't he?

    Many people's premium who receive subsidies (none / 0) (#55)
    by MO Blue on Thu Dec 24, 2009 at 03:20:50 PM EST
    will come in over 8% of their income in the both the House and the Senate's plan. Here is a chart I found. I think it is still accurate. link

    It is my understanding that if the premiums for say the silver plan (70% Actuarial Value) is more than 8% of your income, you would need to get the Bronze plan (60% Actuarial Value). IOW, you receive a  waiver for the mandate only if every plan on the exchange exceeds 8% of income.  


    I also checked it @ 42k a year (none / 0) (#59)
    by nycstray on Thu Dec 24, 2009 at 03:51:41 PM EST
    to see how much they would subsidize an income close to the cutoff and it came in at 9.8% of the premium holder's income.

    I wish they had a calculator up for the Bronze plans and the catastrophic. It looks like they want us to buy something, ANYTHING! Kinda the same that Obama asked in for a bill, 'give me something, ANYTHING! to sign'. I can't imagine the catastrophic would be more than 8%. What a crock of sh*t. Those at the top (bottom?) of the subsidy range get screwed along with those just out of range. The dollars in the calculator are 2009, I wonder what 2014's going to look like . . . .


    The Senate lowered the percentage (none / 0) (#60)
    by MO Blue on Thu Dec 24, 2009 at 04:19:38 PM EST
    for the higher end of the subsidies by decreasing the subsidies for people at the lowest level.

    The health reform bill that Senate leaders unveiled on November 18 makes health coverage more affordable for millions of households of modest means, as compared to the bill that the Senate Finance Committee approved last month. The amounts that many families and individuals would pay for coverage would be less than under the Finance Committee proposal.

    For people between 134 percent and 154 percent of the poverty line, however -- people with incomes around $25,000 to $28,000 for a family of three -- premiums would actually be higher than the already significant amounts they would have to pay under the Finance Committee bill. Modifications are needed at some point as the legislation moves forward to ensure that near-poor families and individuals do not face insurance premiums and cost-sharing charges that many of them could have difficulty affording.

    Gosh, d'ya think? (none / 0) (#80)
    by Cream City on Fri Dec 25, 2009 at 12:54:29 AM EST
    This is one of the reasons why I cannot support whatever comes out of Congress, because neither body had solid data upon which to act at this point.  Therefore, to act now was irresponsible and the worst excuse for governing seen since . . . since Repubs ran Congress.  No improvement now.

    And that's just one of the reasons.


    Most subsidized policies (none / 0) (#52)
    by MO Blue on Thu Dec 24, 2009 at 02:24:42 PM EST
    under the Senate bill are classified as silver policies and have an actuarial value of 70%. IOW, a 70/30 split between what the insurance pays and the amount the insured pays.

    I so admire his words (none / 0) (#79)
    by Cream City on Fri Dec 25, 2009 at 12:47:40 AM EST
    but we must stop short of going with Chief Joseph on his most famous quote, that he "would fight no more forever."

    I'm going to keep fighting -- but it has to be for me and mine now, as I'm no longer among any "us" in a party.

    Elect Corporatists (none / 0) (#81)
    by Honyocker on Fri Dec 25, 2009 at 01:16:31 PM EST
    which is what the Democrat leadership and Barack Obama are, and you get corporatism.  The health care legislation that passed is two thousand plus pages of an unholy alliance between big government and big business, with no regard for individual empowerment or markets. It isn't that complicated, folks, and Jeralyn's prediction about the near future is accurate, though likely understated.

    Yes and no about Obama keeping promises (none / 0) (#89)
    by mcl on Sat Dec 26, 2009 at 12:32:26 AM EST
    Obama's promises changed over time. You can find a video from his weekly address on 17 July 2009 in which Obama specifically promises not to sign a bill unless it has a public option. In a 2007 NPR interview, Obama states that as president, he would (more details here) "require all children to have health insurance, and employers to offer employee health benefits or contribute to the cost of the new public program. Expand Medicaid and SCHIP and create the National Health Insurance Exchange through which small businesses and individuals without access to other public programs or employer-based coverage could enroll in a new public plan, like Medicare, or in a range of approved private plans."

    In his 2008 online platform (link to PDF), Obama promises that "any American will have the opportunity to enroll in new public [health care] plan."

    On the other hand, during his presidential debates Obama never mentioned a public option, and throughout his 2008 campaign, most of Obama's speeches talked about the desirability of a public option but did not specifically promise to create one.

    So the evidence seems mixed. Obama made campaign promises in his platform, but as we all know, a campaign platform represents a set of aspirations and it's not fair to hold a candidate to account if s/he fails to enact every single one of the elements in the party platform. In America, the president's ability to act (outside of war-making, and a handful of executive orders governing national parks, etc.) remains limited by congress's ability to legislate.

    In a general sense, Obama promised to push for health care reform and he did that. He never promised a single-payer system, and he never pushed that plan, so no one can blame him for not enacting single-payer. Obama talked about public exchanges from the git-go, and the HCR bill contains public exchanges. The problem remains that with single-payer off the table, Obama had no big stick to compel insurance monopolies to change their behavior, and the current system has no real incentive to change without the threat of fundamental change to a non-profit system hanging over their heads.

    At this point the big question remains: will this health care bill merely involve a return to business as usual for our broken health care system (as the TARP bailout represented just a speed bump for the U.S. banking system and has now returned to business as usual with no reform and every prospect of a much bigger systemic breakdown sometime soon)?  Or will this health care bill mark the start of incremental change leading to genuine reform (as in the individual state legalization measures for marijuana, which appears to raise the prospect of a genuine change in the failed and futile "war on drugs")?

    Briefly, our overriding question now is whether this health care reform bill will be a compromise that turns into a trainweck like the No Child Left Behind bill of 2001, or a compromise that contains only a few progressive provisions like the Civil Rights act of 1964 but which subsequently gets expanded and amended to produce genuine lasting change, as the subsequent civil rights legislation did in 1966 and 1968.

    At present, the HCR bill requires insurance companies to create public exchanges which in effect compete with the for-profit insurance sold by the companies themselves. The stick to force for-profit insurance companies to do this is the threat of a trigger which creates a full public option if the insurance companies drag their heels.

    The devil's in the details, though. What happens if the insurance cartel simply bribes congress to look the other way as the insurance exchange fills up with uninsurable sick people and insurance premiums for the public exchange rise to, say, $20,000 per month?  

    We also don't know what will come out of reconciliation. The senate has passed HCR but the house and senate bills still need to get reconciled, and only 50 votes are needed to pass the reconciliation bill. Lieberman and the other  sociopaths will play little part in a 50-vote reconciliation bill.

    The HCR bill consists mostly of experiments design to cut costs. The insurance exchanges and other highly-touted provisions only amount to a few pages; most of the HCR bill involves various experimental cost-cutting plans. Some commentators have argued that over the long run these provisions will dramatically reduce America's health care costs and produce a massive reform in our health care system, as FDR's patchwork reforms succeeded in dramatically boosting farm productivity from the late 1930s on.

    But will they?  The No Child Left Behind legislation did not result in fundamental reform of our broken educational system -- American teens score below all other developed nations on math and science, despite the No Child Left Behind legislation. Will this health care reform bill be a failure like the NCLB, serving only to make things worse?  It's easy to see how things could get worse -- if you're one of the working poor who can't afford private insurance but you have to pay a fine because of the mandates, now you'll have even less money than you did before and you'll still have no insurance. Meanwhile, if the insurance companies bribe congress into letting them using the public exchanges as dumping grounds for uninsurable sick people, the premiums for the public exchange insurance could easily wind up being much higher than the unaffordable regular insurance offered by for-profit companies. So if you're a recent college graduate working part-time at UPS for minimum wage or a single mom with two kids working at Wal*Mart, this HCR could reduce your income with fines without providing you insurance. That's worse than the current system.

    With for-profit insurers left in charge of a gross inefficient fragmented health care system, why would they change?  How can reform occur?  

    One of the fundamental drivers behind the high cost of U.S. health remains the profit motive which induces doctors to act as businessmen, start their own storefront labs, and sell wildly overpriced medical tests to hospitals (see this New Yorker article for evidence). Where doctors act as businessmen in a fee-for-service system, costs explode...and not merely by 10% or 20%, but bya factor of 5x or 7x (500% to 700% more expensive than medical services in other countries), with typical fees for common services like a routine office visit running $151 in America but $22 in countries like Germany. What does the HCR bill do to discourage doctors from setting themselves up as businessmen and raking in vast amounts of cash on insanely overpriced imaging scans and medical tests?

    I see nothing in the current HCR bill which prevents doctors from setting themselves up as businesses and charging all the market will bear, which remains the fundamental root of our astronomical medical costs.