What Now On Health Care Reform?

I have never proclaimed to know much about health care and I think I have backed up that position by not writing much about it. That said, I have come to see the public option/individual mandates/taxing the wealthy to pay for it ideas as not a bad start to build on. But all of this seems in jeopardy now and there is a growing debate as to whether what is on the table now is actually counterproductive to achieving lasting and meaningful health care reform. Kevin Drum writes:

Scott Lemieux isn't happy with the compromise healthcare bill being put together in the Senate [--] "The normal justification for passing a compromise bill is that once a new system is entrenched it can be tweaked later. But I don't think it applies in this case. The public option is the core of the reform; a Blue Dog bill isn't so much half a loaf as a few meaningless crumbs. . . ."

. . . Ezra Klein disagrees [--] "What has kept health-care reform at the forefront of liberal politics for decades is moral outrage that 47 million of our friends and neighbors are uninsured. That medical costs are one of the leading causes of bankruptcy in the United States. . . ."

Kevin himself stresses community rating. Lambert thinks the entire thing is a sham and that only single payer makes sense. So what do I think now? I'll tell you on the flip.

I am still persuaded that a robust public option, individual mandates and taxing the wealthy to cover costs would constitute real health care reform that would lead to even better reform. I am not at all convinced that anything short of this is worth doing.

And we seem to be in great danger of doing much less than this. President Obama's team is quick to capitulate (already they are saying yes to "co-ops" over the public option.) They simply seem to be inept at negotiation with Congress.

Atrios says ". . . unless progressives make it clear that they're willing to torpedo a sh*t bill a sh*t bill is what we will get." Obama's team has signalled they won't torpedo a sh*t bill. So who will torpedo it? Certainly Nancy Pelosi, despite her bluster, won't. She'll do whatever Obama tells her to do.

Speaking for me only

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    if it does not contain the things you list (5.00 / 8) (#1)
    by Capt Howdy on Wed Jul 29, 2009 at 11:01:30 AM EST
    it will be nothing but a mandate to buy insurance and a giveaway to insurance companies.
    we should try to stop it.  it is worse than nothing.

    A f'ing men (none / 0) (#119)
    by Faust on Wed Jul 29, 2009 at 10:00:07 PM EST
    to that.

    Obama is too pragmatic (5.00 / 1) (#11)
    by Rashomon66 on Wed Jul 29, 2009 at 11:15:11 AM EST
    Obama seems too willing to compromise on a Single Payer plan in order to get a plan that he believes will pass - even if that bill is inefficient. I sure wish he and the Dems would fight for the best plan rather than a compromised one. I'm in agreement with Scott Lemieux.

    Obama: for single payer before he was against it (none / 0) (#64)
    by lambertstrether on Wed Jul 29, 2009 at 12:18:53 PM EST
    Bill Moyers:

    In 2003, a young Illinois state senator named Barack Obama told an AFL-CIO meeting, "I am a proponent of a single-payer universal healthcare program. ... All of you know we might not get there immediately because first we have to take back the White House, we have to take back the Senate and we have to take back the House."

    Cue hollow laughter.


    Presidential Primaries (none / 0) (#94)
    by BackFromOhio on Wed Jul 29, 2009 at 01:46:15 PM EST
    Did Obama change his position during the primary, and wasn't this a main bone of contention between the Clinton & Edwards health plans on the one hand, and Obama's on the other?

    Yes (5.00 / 1) (#102)
    by jbindc on Wed Jul 29, 2009 at 02:38:45 PM EST
    He kept hitting Hillary with the fact that she wanted a mandate for coverage and he only wanted a mandate for children.  Her argument was that if you didn't have a mandate, it would equate to about a $900 tax on everybody else with insurance.

    And now we'll get (5.00 / 1) (#110)
    by BackFromOhio on Wed Jul 29, 2009 at 07:23:15 PM EST
    zilch of any value, but a good chunk of taxpayer debt

    Yeah (none / 0) (#96)
    by squeaky on Wed Jul 29, 2009 at 01:50:02 PM EST
    Getting there is not a straight line. But if Hillary had been elected,  the Congresscritters would be falling all over themselves to enact a single payer plan. Wow what a woman...  

    Well, the real issue (5.00 / 1) (#109)
    by Jjc2008 on Wed Jul 29, 2009 at 07:16:41 PM EST
    is that Hillary was demonized by SOME Obama supporters for being "pragmatic".  In the meantime, some of us tried to explain that once you have dealt with these obstructionists jerks, one learns some hard lessons.   Bill and Hillary tried hard to push a more progressive agenda and got burnt.  Obama learned from them but perhaps he is not pushing hard enough.

    I agree that there is no way the right would be any better with Hillary about anything. I get that. But I knew they would be every bit as obstructionist obnoxious with Obama or any democrat.   That was my issue...that SOME implied that Hillary (and Bill) were personally responsible for the right's nasty, obnoxious hateful attitude.  And many of us knew better.


    Well That May Be Your Issue (none / 0) (#114)
    by squeaky on Wed Jul 29, 2009 at 07:45:09 PM EST
    But were Hillary the POTUS she would have exactly the same Democratic congresscritters to deal with, whose constituents are not for single payer insurance, imo. All the experience in the word can not make voters force their Reps to vote on an issue that they are wary about. That is the problem. The evil forces have a grip on the populace and many of their representatives.

    As great as Hillary is her situation would be exactly the same or worse regarding winning over morons, on the Dem side of the aisle, forget about the majority of the GOPers, imo.


    That's what I said (none / 0) (#118)
    by Jjc2008 on Wed Jul 29, 2009 at 09:22:56 PM EST
    before the election and now......didn't matter whether it was Hillary or Obama.  The jerks would be jerks no matter what.  That was my frustration...the people who insisted that the right wing nuts were worse because of the Clintons. I don't buy it.

    Sorry (none / 0) (#120)
    by squeaky on Wed Jul 29, 2009 at 10:18:32 PM EST
    I do not understand your penultimate sentence.

    the people who insisted that the right wing nuts were worse because of the Clintons. I don't buy it.

    What don't you understand? (none / 0) (#122)
    by Jjc2008 on Thu Jul 30, 2009 at 07:30:06 PM EST
    Those people who frustrated me were Obama supporters; particular one.  They were people who insisted the right wing nutters became nutters because of the Clintons.   In other words, they blamed the victims.  The Clintons were victimized by a group of right wing people who used lies, spin, and corporate money to push scandals that did not exist.  

    Today those same right wing nuts are pushing lies and fear to hurt Obama.  Instead of scandals and classism they are using racism.  

    In other words, the victims be it the Clintons or the Obamas are not the cause of the right wing nuttery.

    Do you get it now?


    Yes (none / 0) (#123)
    by squeaky on Thu Jul 30, 2009 at 07:38:01 PM EST
    Obviously, I agree. Never meant to suggest that Obama or Clinton were the cause of right wing nuttery. They are nuts all by themselves.

    If Obama really was pragmatic, he'd (none / 0) (#93)
    by inclusiveheart on Wed Jul 29, 2009 at 01:42:55 PM EST
    get it together and push hard for a single-payer - Medicare for All - system because that is really the most cost-effective and health-effective system of health insurance and coverage.

    Really (none / 0) (#95)
    by squeaky on Wed Jul 29, 2009 at 01:46:57 PM EST
    And what planet are you from. The morons in the senate won't even go for a plan that opens the door for lessening the insurance co's take, namely a public option.

    Pragmatic to go with what you want??  Well maybe you should go out into the heartland and convince those morons out there that single payer is not tantamount to being occupied by communist china.

    lol, pragmatic my a$$..


    There are two ways of approaching (5.00 / 2) (#103)
    by inclusiveheart on Wed Jul 29, 2009 at 03:08:15 PM EST
    a problem in Washington:

    1. Focus on the politics
    2. Focus on the project

    In this case, the only route to success is to focus on the project.  The big mistake that the Obama administration has made is not to define the gold standard of care - which they could have easily sold to the public - and therefore would have been in good position to combat the sabateurs in Congress.  By leaving the project undefined for so long that the American public never really was able to latch onto some appealing specifics of having good healthcare; and by focusing almost myopically on "bipartisan" action, they have given the detractors significant openings to undermine the reform.

    John Kyl was on Fox News Sunday this weekend and cleverly pointed out that the Democrats have the numbers to pass both bills without the GOP.  He then made the claim that the GOP is therefore not obstructing healthcare reform and the reality is that he is NOT wrong.


    Oddly enough, the best critique (none / 0) (#112)
    by BackFromOhio on Wed Jul 29, 2009 at 07:25:53 PM EST
    of health insurance legislation and comments by Repubs and others came this past Sunday from Fareed Zakaria at the end of his weekly program on CNN.  I'll try to find if there's a transcript

    I'd like to see, but I will say it isn't odd. (none / 0) (#117)
    by inclusiveheart on Wed Jul 29, 2009 at 08:02:52 PM EST
    The Democrats have contorted themselves so much that their pretzel bills have tons of legitimately criticized holes now.  It is their own fault really for failing to clearly define their objectives for the American people.  They've acted as cowards - this is not the "bold" "change" we were promised from this Administration or Congressional majority.

    What is odd is that (none / 0) (#121)
    by BackFromOhio on Thu Jul 30, 2009 at 09:01:59 AM EST
    Zakaria's focus is usually foreign policy

    Fareed on healthcare 7-26 (none / 0) (#124)
    by BackFromOhio on Fri Jul 31, 2009 at 04:24:14 PM EST

    Go to the very end of the transcript, after conversation with Roubeni & others on economy.


    I'll have to see the parameters ... (5.00 / 1) (#15)
    by Robot Porter on Wed Jul 29, 2009 at 11:17:42 AM EST
    of the public option.  The ones in previous bills weren't enough.

    The subsidies weren't large enough, making the public option not affordable for many.

    And, if mandates are included, insurance companies may prey upon these people with plans that have overly high deductibles or the barest of coverage.

    In reference to the public option the Democrats must be able to answer these three question for the average American:

    When does it start?
    How much does it cover?
    How much will cost?

    And if the answers to these three questions are:

    Not soon enough.
    Not everything.
    Too much.

    It's not a real public option.

    I would go for a bill with just about (5.00 / 1) (#18)
    by andgarden on Wed Jul 29, 2009 at 11:21:09 AM EST
    any public option. You can expand it later (a la SCHIP last year).

    Much harder to expand something that doesn't exist.


    That's naive ... (5.00 / 1) (#29)
    by Robot Porter on Wed Jul 29, 2009 at 11:30:59 AM EST
    a public option could be just be a dumping ground for the very ill, thus a boon to insurance companies, but not offer real access to the average citizen.

    I don't see any impetus to expand a public option is such a scenario.

    And this is very possible.


    Is Medicare a dumping ground for old people? (5.00 / 1) (#31)
    by andgarden on Wed Jul 29, 2009 at 11:32:12 AM EST
    The public option(s) ... (none / 0) (#37)
    by Robot Porter on Wed Jul 29, 2009 at 11:35:53 AM EST
    currently on the table bear no resemblance to medicare.

    Entirely disagree (5.00 / 1) (#40)
    by andgarden on Wed Jul 29, 2009 at 11:38:25 AM EST
    Yes, but (5.00 / 1) (#36)
    by KeysDan on Wed Jul 29, 2009 at 11:35:45 AM EST
    we already have  good public plans in place that could, with appropriate modifications, be easily expanded.  Medicare and Medicaid.  Of course, that is not in the cards either.

    And that's what I'm ... (5.00 / 1) (#38)
    by Robot Porter on Wed Jul 29, 2009 at 11:36:55 AM EST
    in favor of "medicare for all."

    As, I might add, are ... (5.00 / 1) (#39)
    by Robot Porter on Wed Jul 29, 2009 at 11:37:37 AM EST
    70+% of the population according to polls.

    And, it also seems (none / 0) (#45)
    by KeysDan on Wed Jul 29, 2009 at 11:41:57 AM EST
    like Medicare, or a Medicare derivative, is what many people think is being proposed.

    As they do ... (none / 0) (#48)
    by Robot Porter on Wed Jul 29, 2009 at 11:48:27 AM EST

    "70+% of the population" (none / 0) (#71)
    by NYShooter on Wed Jul 29, 2009 at 12:28:48 PM EST
    are content to sit on their couches and express their unhappiness through Ameican Idol.

    The "Streets" ended the Viet Nam war; only the Streets will get us universal health care.


    I am seriously convinced that - (5.00 / 3) (#80)
    by Anne on Wed Jul 29, 2009 at 12:47:13 PM EST
    assuming this awful plan is passed - when people begin to understand that

    (1) those who need help now will be waiting another 3 years+ for the implementation date - conveniently after both the 2010 and 2012 elections,

    (2) if they have employer-sponsored coverage they will be prevented from opting for whatever public plan might be available, even if it is better and cheaper (which, admittedly, does not appear likely at this stage),

    (3) insurance companies may not be bound by new regulations with respect to existing plans,

    (4) they may be mandated to spend money they don't have on policies that have high deductibles they cannot afford to meet which means they still cannot get the care they need, and

    (5) neither their premiums nor their out-of-pocket costs will be decreasing over the long-term (think low introductory credit card interest rates that suck people into thinking they are getting a great deal) - people will be taking to the streets.

    People have called, e-mailed, faxed, visited, written, begged, pleaded, cried, and generally done everything humanly possible to be heard by their members of Congress, largely to no avail.  Huge percentages of the population want some form of single-payer/universal coverage, and the best they have been able to come up with is weak, ineffective, just as costly "reform" that has more guarantees and protections for the insurance industry than it does for you and me.

    Some legacy, huh?


    Sibelius: The legislation will be crafted... (5.00 / 3) (#68)
    by lambertstrether on Wed Jul 29, 2009 at 12:27:53 PM EST
    specifically to prevent evolution into single payer.

    And I have yet to see any of the A list public option advocates articulate a plausible scenario were public option turns into single payer. (See this post and discussion at OpenLeft). If you have a link to such a scenario, I'd be very glad to see it.

    It would seem this is an easy case to make if, in fact, it could be made. So I conclude it can't be made.

    What we got instead was bait and switch, where public option was sold as being a Medicare-like program covering 130 million people, and ending up covering 9 million in a ghettoized ("firewalled") Health Exchanges. Will Dr. Rube Goldberg please pick up the white courtesy phone?


    Not during the Obama (none / 0) (#21)
    by dk on Wed Jul 29, 2009 at 11:23:18 AM EST
    administration.  They have been very clear about keeping up the firewall.

    So, if that's the case, better to wait until he leaves office and try again, rather than give away more money to for-profit insurance companies (a la TARP last year).


    I'm sorry, but that's just insane (5.00 / 1) (#22)
    by andgarden on Wed Jul 29, 2009 at 11:24:36 AM EST
    There are no guarantees about what Congress will look like in the future.

    Oh, so so serious. (none / 0) (#24)
    by dk on Wed Jul 29, 2009 at 11:26:49 AM EST
    David Broder would be proud.

    pffft (5.00 / 1) (#26)
    by andgarden on Wed Jul 29, 2009 at 11:27:20 AM EST
    That's my biggest worry (5.00 / 6) (#46)
    by gyrfalcon on Wed Jul 29, 2009 at 11:44:15 AM EST
    "And, if mandates are included, insurance companies may prey upon these people with plans that have overly high deductibles or the barest of coverage."  Being forced to buy insurance with money I don't have that doesn't cover much of anything scares the wits out of me, frankly.

    I think we're in the same club there (5.00 / 4) (#53)
    by nycstray on Wed Jul 29, 2009 at 11:58:56 AM EST
    High deductibles (5.00 / 7) (#63)
    by MO Blue on Wed Jul 29, 2009 at 12:17:04 PM EST
    If I'm a poor person who does not qualify for Medicaid, being forced to pay any premium for a high deductible plan would be worse than having no insurance at all.

    I will still not get preventative care because I cannot afford to pay for it. In fact, I will have even less money than I had before this so call insurance reform plan was adopted.

    Any cost savings that could be realized by timely preventative care would be lost to the entire population.  


    Today, you pay nothing and get nothing (5.00 / 6) (#70)
    by lambertstrether on Wed Jul 29, 2009 at 12:28:42 PM EST
    That's a lot better than getting nothing after being forced to pay for it.

    Sounds like we are going to be taxed (5.00 / 2) (#79)
    by my opinion on Wed Jul 29, 2009 at 12:43:56 PM EST
    by the health insurance companies with no representation or recourse.

    Yes, we need to (5.00 / 2) (#49)
    by KeysDan on Wed Jul 29, 2009 at 11:50:25 AM EST
    settle on the elements of a good public option, before falling on swords over it.   If it is hobbled to the extent that it destined to become a demonstration project for failure, let it go.  After all, the public option was a sop to progressives in lieu of a good single payer, or a Medicare for all.  Maybe, we will be better off to expend energies toward high standards, coverage for all, at all times, and strong regulations and a structurally effective regulatory board.

    Can we add: (none / 0) (#30)
    by KeysDan on Wed Jul 29, 2009 at 11:31:49 AM EST
    who is eligible?

    Okay ... (none / 0) (#42)
    by Robot Porter on Wed Jul 29, 2009 at 11:40:46 AM EST
    just wanted to keep the list short.

    But that's probably a necessary addition.

    Though it would probably be answered in the first question if you weren't eligible.


    Robust public option? (5.00 / 1) (#20)
    by dk on Wed Jul 29, 2009 at 11:22:02 AM EST
    I don't get this.  The bill that passed the House committees didn't have a robust public option.  There is no chance anything to the left of that will come through this year, right?  So, if that's the case, why are we even talking about a robust public option anymore?

    inept at negotiating (5.00 / 3) (#23)
    by Dadler on Wed Jul 29, 2009 at 11:25:09 AM EST
    i'd suggest it isn't ineptness at this point, but more likely is simply another sign that Obama, when it comes down to it, stands for next to nothing except whatever he can pass and then pass off as "change" to whomever will believe that load of sh*t.

    obama is conservative, that much seems VERY clear to me at this point.  the man who campainged on change is, in reality, very averse to anything that really IS change.

    "They simply seem to be inept (5.00 / 4) (#33)
    by my opinion on Wed Jul 29, 2009 at 11:33:55 AM EST
    at negotiation with Congress."

    Excellent statement. The key word is "seem." As some others would say, this is a feature not a bug.

    The bubble at work (5.00 / 7) (#35)
    by TheRealFrank on Wed Jul 29, 2009 at 11:34:12 AM EST
    I think this is a good example of the Beltway Bubble at work. You start with something decent. Then, in the alternate universe of the Hill, "bipartisanship" becomes more important than results. Slowly but surely, you move further and further away from something that works, while all the Very Serious people on the Hill nod very seriously how the newest, further watered-down compromise, makes sense, and how wonderfully bipartisan it is.

    It is maddening to watch.

    I'm also getting really sick of this "we need 60 votes" crap. The Republicans passed all sorts of crap when they had just 52 total.

    The thing to understand (5.00 / 8) (#41)
    by jbindc on Wed Jul 29, 2009 at 11:39:48 AM EST
    is that if the Dems had 85 votes, they'd still make excuses.

    Some House Dems are sick (5.00 / 1) (#84)
    by Cream City on Wed Jul 29, 2009 at 01:06:08 PM EST
    of the Blue Dogs lying down for a lousy bill that won't help the sick:

       Rep. Tammy Baldwin (D-Wis.), said that Waxman is in danger of losing the votes of liberals like herself and other supporters of a public option in the negotiations."There's a point where you lose New Dem and Progressive votes on the bill," Baldwin said. "Some of the proposals they're bringing forward would have the net effect of weakening the public option."

    Not enough of them this time to make a difference, but it seems to be a rising tide of unhappiness with leadership that may lead to something. . . .


    Absent a true single-payer plan, (5.00 / 7) (#44)
    by Anne on Wed Jul 29, 2009 at 11:41:43 AM EST
    which for reasons I do not agree with has been termed "politically infeasible," a public option that meets the goals of insuring the largest number of people, while managing and reducing costs, will have to be configured much, much differently than how the Congress is doing that.

    From PNHP:

    The public option refers to a new public plan that would compete with private health insurers in an effort "to keep them honest". It is a concept trumpeted by Jacob Hacker, now a professor of political science at the University of California Berkeley. His original idea, as first envisioned in the 1990s, was that a large public program, operated along the lines of Medicare, could cover as much as one-half of the non-elderly population by shifting all or most of the uninsured, as well as all Medicaid and SCHIP enrollees, into the plan from the start.  Because of its size and efficiency, such a large plan would be able to keep its premiums much lower than private plans, thereby increasing its attractiveness to enrollees. In addition, all non-elderly Americans, whether privately insured or not, would be eligible to participate. Government subsidies would be extended to those unable to afford the plan. Private insurers would be required to offer the same minimum benefits as the public plan.

    So the initial idea was premised on the idea that a public plan could bring needed competition into the financing of health care. Forget that dream.  Although the current House and Senate bills both include a "public option", it is in name only. What might have roared like a lion is becoming, at most, a mouse that barely squeaks. The details change every day, but already these kinds of changes from Hacker's original concept make it a policy non-starter:

    •  Many people with private insurance who want to change will not be able to select the public option

    •  The public plan may not kick in until 2013 or until such time as private plans have been demonstrated not to save money (a so-called "trigger")

    •  Whatever new regulations that are imposed by the reform bill will only apply to new private plans; existing plans will be grandfathered in as is

    •  Private insurers worry that a public plan would crowd them out by undercutting their premium levels, so they lobby to keep the public program small

    •  The current proposals in Congress do not impose caps on private insurance premiums; nor do they allow the public option to significantly lower its premium rates below private plans

    •  The public plan will not be "pre-populated" with all Medicaid and SCHIP enrollees from the start, thereby keeping the plan small

    •  Instead of initial coverage estimates in the range of 120 million enrollees by public plan advocates, the Congressional Budget Office (CBO) estimates that only 10 million would be enrolled because of the fine-print restrictions now being placed on the plan within Congressional committees. These restrictions are being heavily lobbied by the private insurance industry to ensure that they won't have any real competition.

    If all people do is listen to what is being said about Congress' plan, by members of the committees, as well as the president, it's very hard to get a clear understanding of what this plan is all about.  As the committees have been tinkering with things, their messaging has not changed much - unless you are paying attention to the details so you know when you are being bamboozled - so people are still thinking "public option" is the same public option from the beginning of this process when it was termed "robust."

    It's getting weaker by the day, and moving farther away from helping people who need care.

    It's all very discouraging.

    Politically infeasible means (5.00 / 1) (#58)
    by ruffian on Wed Jul 29, 2009 at 12:07:26 PM EST
    politicians don't want it. It is a self-perpetuating phenomenon.

    Not only won't we get a public option, but (5.00 / 1) (#50)
    by Teresa on Wed Jul 29, 2009 at 11:51:19 AM EST
    my link button is broken. I've tried and tried but no luck.

    If you go to Congressman Waxman's site and click Health Care Reform and then America's Affordable Health Choice Act of 2009, District by District Impact, you can see how few people will have their taxes increased to pay for the public option part of the bill.

    In my district, it's only 1% so that 67,000 people can have health insurance. 14,100 small businesses can receive a 50% credit on health insurance. From what I've read about the cost, I don't think many uninsured can afford it anyway after the three year wait. But it's better than what they are going to settle for now. I'm thoroughly disgusted about this. Obama should be fighting hard for this. I hope every Democrat who refused the public option loses their next election.

    I'll do the short link in case anyone wants to look at their district. 13% of my district are uninsured but we can't make 1% help pay. And, why do Republicans and Blue Dogs hate small business? They stand to get the greatest benefit of all.


    Per Greenwald, what has happened (5.00 / 1) (#51)
    by oculus on Wed Jul 29, 2009 at 11:55:25 AM EST
    re health care reform is what was always going to happen.  

    Progressives should never ever ever lose (5.00 / 4) (#52)
    by Militarytracy on Wed Jul 29, 2009 at 11:56:51 AM EST
    their firm grip on fighting for single payer at this negotiating table! Once that is off the table it is all about degrees of losing for any American falling through the many many cracks that other solutions will provide.  A robust public option is also a good place to build on in my opinion, and we can all sorts of places if we get that.  What is happening though seems preditable to me.  When the left is willing to take single payer off the table and take the argued welfare of the entire United States population off the table, it is all about degrees of loss. And in the world we live in right now, that is going to be substantial loss for those who will be losing!

    In CA, for example, Governor just cut (5.00 / 2) (#54)
    by oculus on Wed Jul 29, 2009 at 11:59:56 AM EST
    state funds for CPS, MediCal, and Healthy Families.  

    We aren't going to GET a "robust" ... (5.00 / 2) (#73)
    by lambertstrether on Wed Jul 29, 2009 at 12:33:00 PM EST
    public option. It's not on offer in any of the legislation. See, again, here.

    What the bills on offer actually do is offer a guaranteed, captive market to the insurance companies. In other words, the mandate is a bailout.


    So I did not (none / 0) (#74)
    by Big Tent Democrat on Wed Jul 29, 2009 at 12:34:57 PM EST
    misdescribe your position then did I?

    I wouldn't have used those exact words (none / 0) (#81)
    by lambertstrether on Wed Jul 29, 2009 at 12:51:49 PM EST
    but if I'd felt misrepresented, I would have remarked upon it! Do I need to re-read more carefully? ;-)

    And thanks for the link, too.

    * * *

    I'm pretty much focused on the short term right now. I don't want something hideous to emerge before the recess. Legislation passed NOW NOW NOW has a very bad track record, and although the problem has been with us for a long time, the particular sausage being made has not.

    NOTE On "only single payer makes sense," I'd say it's the only thing that makes sense in the American context. A national health service, for example... Now that's a real non-starter. Heavily regulated insurance companies, like Germany has, might be an option (although Germany's culture is not America's). But of the options on offer, which boil down to HR3200 minus whatever the Senate subtracts from it vs. HR676 (single payer), only single payer makes sense. I don't for a minute believe the fear tactic that if we don't get it done now we don't get it done. I think that if the Democrats suffer an awful lot of pain between now and the midterms, we'll get a much better deal that saves more lives and money, possibly with a legitimate transition path to single payer. And yes, "public option" is a sham. You can't run a bait and switch in good faith. Na ga happen.


    What we should have been fighting for (none / 0) (#66)
    by cenobite on Wed Jul 29, 2009 at 12:20:02 PM EST
    Was "VA for all", a British style National Health Service where the government owns and runs it all.

    Then we could have settled for Medicare for all, and the DFHs could be shunned as unserious without the complete fail we're looking at now.


    While I firmly believe that a single payer (5.00 / 5) (#56)
    by MO Blue on Wed Jul 29, 2009 at 12:04:49 PM EST
    would be the best and most cost effective health care system, I would definitely accept a ROBUST public option as an alternative.

    Congress is not giving us the option for a ROBUST public option. What Congress is offering is an extremely weak, watered down, severely restricted public option that was designed by Congress so that it can in no way compete with the insurance companies or change their behavior. To quote Ian Welsh:

    I'll settle for a good public option, or even a non-sucky one. But I'm becoming convinced that any public option will either be too compromised, or non existent, and at that point, all that happens is you have slashes to Medicare and Medicaid, forced purchase of bad insurance, and through those purchases more money being pumped into the system. link

    Anyone who wants to educate themselves on how the insurance industry works should also read Ian Welsh's "How insurance works and why private insurance costs more than universal government insurance." link

    Mo, you constitently write ... (5.00 / 3) (#61)
    by Robot Porter on Wed Jul 29, 2009 at 12:16:44 PM EST
    some of the best stuff on this issue.

    Most of what I write has been gathered from (5.00 / 1) (#69)
    by MO Blue on Wed Jul 29, 2009 at 12:28:10 PM EST
    the few web sites that are willing to do research on the issue and not just regurgitate Dem talking points. A h/t to Correntewire and lambert for introducing me to Ian Welsh who truly understands insurance and health care issues.

    Thanks for the kind words.



    Good research is part ... (5.00 / 1) (#72)
    by Robot Porter on Wed Jul 29, 2009 at 12:31:10 PM EST
    of strong writing.

    A timely email from the President (5.00 / 1) (#57)
    by ruffian on Wed Jul 29, 2009 at 12:05:08 PM EST
    just in...boldface mine

    Dear Friend,

    If you're like most Americans, there's nothing more important to you about health care than peace of mind.

    Given the status quo, that's understandable. The current system often denies insurance due to pre-existing conditions, charges steep out-of-pocket fees - and sometimes isn't there at all if you become seriously ill.

    It's time to fix our unsustainable insurance system and create a new foundation for health care security. That means guaranteeing your health care security and stability with eight basic consumer protections:
    No discrimination for pre-existing conditions
    No exorbitant out-of-pocket expenses, deductibles or co-pays
    No cost-sharing for preventive care
    No dropping of coverage if you become seriously ill
    No gender discrimination
    No annual or lifetime caps on coverage
    Extended coverage for young adults
    Guaranteed insurance renewal so long as premiums are paid

    it goes on to ask me to pass this along to my 'social network'...

    Does not look much like what BTD (and I) would call a good bill. Now, if consumer protection regulations were all I had ever hoped to achieve with a Dem president and Congress, maybe I would be happy with this. Likewise if he had been honest a few months ago and said he did not think he could get real reform done this year, but here's what he could do, and would tackle universal coverage next year after he had paved the way, and gotten troops out of Iraq so we could pay for it easier. (Yes, I am fantasizing here)

    It is entirely possible that he had to promise the insurance companies he would not fight for real reform in order to get them to not fight these consumer protections.

    I think the whole thing was bungled from the start, when he handed it over to the least trusted institutions in America (Congress and insurance companies) to come up with the plan.

    Where it goes from here? Not sure I care anymore.

    For us, the problem's not health insurance (5.00 / 2) (#75)
    by lambertstrether on Wed Jul 29, 2009 at 12:35:42 PM EST
    The problem is health care.

    Now, health insurance and guaranteeing that its money flow continues, that's the problem for Versailles and the administration.

    But it's not our problem.

    Nobody ever died because they lacked insurance.

    They die because they lack care.


    And indeed insurance does not guarantee care (5.00 / 1) (#82)
    by ruffian on Wed Jul 29, 2009 at 12:54:34 PM EST
    as people find out way too late.

    Hey - look on the birght side (none / 0) (#78)
    by jbindc on Wed Jul 29, 2009 at 12:43:25 PM EST
    Waxman says there's a breakthrough on the House version.

    This is not the only place where 'insurance' (5.00 / 1) (#111)
    by allimom99 on Wed Jul 29, 2009 at 07:24:22 PM EST
    has replaced 'care' in the talking points. Listening to Thom Hartmann this morning, he had Hilda Solis on. He asked her a question vis-a-vis healthcare/labor issues, and she started to reply about "health CARE reform," then quickly corrected herself and said "health INSURANCE reform."

    Thom caught it only after she was off the air and wondered aloud if he's actually heard her say that. I heard someone from the administration (sorry, can't remember who) use the phrase yesterday, and I definitely noticed it. I must concur with Lambert AGAIN.


    I read this as (none / 0) (#59)
    by nycstray on Wed Jul 29, 2009 at 12:12:38 PM EST
    No exorbitant out-of-pocket expenses, deductibles or co-pays

    They can still be high, just not ridiculously high {grin}

    *No dropping of coverage if you become seriously ill

    *Guaranteed insurance renewal so long as premiums are paid

    I hope they have plans for the unemployed and the seriously ill who can't work who may not have been when they got their insurance


    grin (none / 0) (#62)
    by ruffian on Wed Jul 29, 2009 at 12:16:55 PM EST
    I'd love to pick it apart line by line, starting with 'friend' (is that all I mean to him?) but my lunchtime is sooo short....

    anything about protection (none / 0) (#88)
    by hookfan on Wed Jul 29, 2009 at 01:19:07 PM EST
    from premium inflation? No? I didn't think so. What it looks like from the downside where I live is indentured servitude. What happens to you if you can't pay? Premium increases have been averaging double digit for at least the last decade. How are insurance companies going to lessen premium inflation if they can't manage risk through limiting their exposure?

    so (none / 0) (#90)
    by Capt Howdy on Wed Jul 29, 2009 at 01:21:53 PM EST
    Guaranteed insurance renewal so long as premiums are paid

    if you allow your coverage to lapse you are screwed?


    It's not like (5.00 / 1) (#89)
    by NYShooter on Wed Jul 29, 2009 at 01:20:09 PM EST
    we don't have a template to go by.

    Social Security provides a basic floor for life's necessities, while not preventing anyone from augmenting it with out-of-pocket retirement plans.

    Ezra (4.83 / 6) (#12)
    by lilburro on Wed Jul 29, 2009 at 11:15:59 AM EST
    may have a point, but he is constantly moving the goalposts and pretty much defends whatever is put out there by the Obama Admin.  He has a lot of info but I sometimes don't know what to think.

    True dat (5.00 / 4) (#17)
    by Big Tent Democrat on Wed Jul 29, 2009 at 11:20:12 AM EST
    Ezra has ensconced himself well in the Establishment. He is hard to take very seriously now I hate to say.

    I used to rely on him on this issue but after I saw his accordion-like flexibility on issues during the 2008 campaign, I gave that up.


    Speaking of 2008 (5.00 / 2) (#19)
    by andgarden on Wed Jul 29, 2009 at 11:21:52 AM EST
    Isn't it funny how everyone now agrees that individual mandates will be part of the package?

    And how was that accomplished (5.00 / 2) (#32)
    by lilburro on Wed Jul 29, 2009 at 11:33:40 AM EST
    other than by fighting for it?

    If Obama wants the public option he will have to fight for it.  And I don't see how sending out mixed messages remotely approaches that.

    Maybe he should've appointed Hillary as his Secretary of Health and Human Services.  At least you'd have another bold voice putting on public pressure.


    That's because in ... (5.00 / 3) (#55)
    by Robot Porter on Wed Jul 29, 2009 at 12:04:12 PM EST
    current proposals it just works as a giveaway to insurance companies.

    You have to buy, most will be restricted from buying public, so they must buy private.


    Exactly (5.00 / 3) (#65)
    by ruffian on Wed Jul 29, 2009 at 12:19:47 PM EST
    Insurance companies love individual mandates, as long as they don't have to compete with the gov. for the business.

    Mandates in, public option out - heckuva job...


    Additionally (5.00 / 2) (#25)
    by lilburro on Wed Jul 29, 2009 at 11:27:02 AM EST
    considering our majorities in both House and Senate, what satisfies Kevin Drum when it comes to healthcare reform is pathetic.  Truly pathetic.  The House and Senate are supposed to create cultural norms?

    I'm no healthcare genius, but at least I'm not producing Cohenesque columns on the subject.


    Wasn't that Obama press conference (none / 0) (#2)
    by oculus on Wed Jul 29, 2009 at 11:02:08 AM EST
    just last week?  What happened?  

    Something happened (none / 0) (#3)
    by Big Tent Democrat on Wed Jul 29, 2009 at 11:04:19 AM EST
    Clearly you're right about Pelosi (none / 0) (#4)
    by andgarden on Wed Jul 29, 2009 at 11:04:56 AM EST
    But I just wonder if there are enough progressives in the House to kill a bad bill. It seems to me that's what we're banking on now.

    If they stick to their guns, the bill will be improved in conference.

    I haven't heard anything this week about those (5.00 / 1) (#13)
    by ruffian on Wed Jul 29, 2009 at 11:16:35 AM EST
    60 Reps that said they would not vote for a bill without a robust public option. I wish they were getting as much publicity as the Blue Dogs. Are they staying behind the scenes for their own reasons, or did they get talked out of that stance? If only some reporter was interested in reporting...

    See The Hill online yesterday (5.00 / 1) (#85)
    by Cream City on Wed Jul 29, 2009 at 01:09:28 PM EST
    re Maxine Waters, Tammy Baldwin, and others starting to speak out about their frustration with so-called leadership.  Yeh, I haven't seen this reported in mainstream media, either.  But some of them read The Hill, so they'll get on it in a few days.  Maybe.

    thanks for the tip! (none / 0) (#86)
    by ruffian on Wed Jul 29, 2009 at 01:14:41 PM EST
    Can't embed link easily (none / 0) (#87)
    by Cream City on Wed Jul 29, 2009 at 01:17:17 PM EST
    on this connection now, but look for the headline "Waters Warns Blue Dogs to Beware 2010."  Also see quote from Rep. Tammy Baldwin in my comment above.

    Except (none / 0) (#92)
    by jbindc on Wed Jul 29, 2009 at 01:35:52 PM EST
    I think more members of the Democratic Party and more Indies would more closely identify with the Blue Dogs than extreme lefties.

    I found this to be an interesting synopsis of what may be going on (written by a guy who worked for W, to be sure, but I think he's pretty accurate on the climate):

    To understand the dynamics at work here, you need to understand the fluid and diverse nature of party identification in America. While liberals and conservatives are the dominant ideological forces in the Democratic and Republican parties, respectively, the ranks of the philosophically pure are too thin to constitute a governing majority. Thus, the two major parties are made up of coalitions that might well break into five or six parties of their own in a parliamentary system.

    Republicans have two primary camps: cultural conservatives from the South and Westerners who emphasize freedom and small government. This leads to the inherent tension in the Republican Party between its traditionalist and libertarian wings. In the not too distant past, the party also had a dedicated, if small, cadre of moderate Rockefeller Republicans in the Northeast, but the last few election cycles have left them all but extinct.

    The Democratic coalition is a much different beast. The liberal wing of the party is anchored in the Northeast and the West Coast, with garrisons in major urban centers throughout the nation. Meanwhile, the more populist, FDR-style Democrats (from whom many of the congressional Blue Dogs are drawn) tend to be concentrated in the Midwest and a few parts of the South that have resisted the growing Republican tide in Dixie.

    The problem that Democrats have had to contend with for the last several decades is that the old New Deal coalition is increasingly susceptible to Republican poaching. This trend began with the South's transformation in the wake of the civil rights movement - a development that Democrats like to blame on Republican exploitations of racial tension. However, the growing influence of the New Left within Democratic ranks was also a decisive factor. As the liberal social views and internationalist foreign policy predilections of the coastal classes began to hold greater sway in the party, many of the populists who had previously trended towards Democrats because of economic issues or labor rights grew increasingly alienated. And today, the parties continue to struggle over a swath of Middle America on precisely these issues.

    During the past two election cycles, a combination of opportunity and initiative have once again given Democrats the upper hand in these perpetually competitive parts of the country. Widespread dissatisfaction with President Bush during his second term (a perception of performance failure is the best way to rend a coalition) gave Democrats a plausible argument for the country to give them a second look. Meanwhile, Bush's own management of the Republican coalition increasingly estranged the party's libertarian wing, opening a new front for Democrats in the West. Capitalizing on this discontent, Democratic leaders in Congress - led by Chuck Schumer and Rahm Emanuel - brilliantly recruited a slate of heterodox candidates who sounded more like Republicans on issues like abortion, immigration, spending, and guns. It may have given George Soros heartburn, but it also gave the Democrats congressional majorities.

    Here's what the Progressive Caucus should do (5.00 / 3) (#76)
    by lambertstrether on Wed Jul 29, 2009 at 12:38:59 PM EST
    Via Kip Sullivan:

    Proposed resolution for the Congressional Progressive Caucus

    WHEREAS the Congressional Progressive Caucus has evaluated the "public option" in HR 3200;

    WHEREAS the CPC has determined that the "public option" in HR 3200 is not "robust";

    WHEREAS HR 3200, therefore, is just another Massachusetts-style bailout for the health insurance industry;

    WHEREAS a Massachusetts-style debacle on a national scale will set back the movement for universal coverage under a single-payer system;

    WHEREAS the CPC has repeatedly put Democratic leaders on notice that they intend to vote against legislation with a weak "public option"; therefore be it

    RESOLVED that the Congressional Progressive Caucus members will instead support an amendment to HR 3200 that replaces HR 3200's language with that in HR 676, The United States National Health Care Act.

    Now, that would be a gamechanger. Trying to think like an 11-dimensional chess player, that might even get us to a "robust" (Medicare-style) public option, mirabile dictu


    BRILLIANT (none / 0) (#113)
    by allimom99 on Wed Jul 29, 2009 at 07:28:44 PM EST
    Why not a Progressive Senate Caucus as well? (none / 0) (#5)
    by Big Tent Democrat on Wed Jul 29, 2009 at 11:05:45 AM EST
    They have graduated (5.00 / 3) (#6)
    by andgarden on Wed Jul 29, 2009 at 11:06:42 AM EST
    from meeting in a phone booth to meeting in a broom closet.

    60 votes (5.00 / 1) (#8)
    by Big Tent Democrat on Wed Jul 29, 2009 at 11:11:04 AM EST
    The Republicans are going to vote en masse against any bill.

    5 liberal Senators can block just like Baucus' Gang of 6.


    My fear (5.00 / 1) (#28)
    by Carolyn in Baltimore on Wed Jul 29, 2009 at 11:28:22 AM EST
    is if there is no public option and it is unfunded mandate for individuals to pay the insurance companies, enough Republicans will vote for it to make it pass even if the progressives all balk.

    And in it's total failure it will still be seen as a Democratic bill.....


    Yup (none / 0) (#9)
    by andgarden on Wed Jul 29, 2009 at 11:12:38 AM EST
    The problem is, who do you really expect to fold first when the President calls?

    Good question (none / 0) (#10)
    by Big Tent Democrat on Wed Jul 29, 2009 at 11:14:01 AM EST
    Let's start with Bernie Sanders, who could care less what Obama tells him on a phone call and build from there.

    2-3 others who might be willing (5.00 / 1) (#14)
    by andgarden on Wed Jul 29, 2009 at 11:17:15 AM EST
    to say no. Franken, Feingold, and Kennedy (who might not be able to show anyway). Well, there are others who would say no, but none for the reasons we want them to.

    Ted Kennedy? (5.00 / 2) (#16)
    by ruffian on Wed Jul 29, 2009 at 11:18:21 AM EST
    Hard to believe this watered down mush is what he has been working for all these years.

    I am sorry he is sick for all kinds of reasons.


    There are enough (none / 0) (#27)
    by eric on Wed Jul 29, 2009 at 11:27:40 AM EST
    progressive Senators to do this.  Sanders, Kennedy, Kerry, Franken, Feingold.  Schumer seems totally for the public option.  Harkin comes to mind, as well.

    Gillibrand has also been getting out (5.00 / 2) (#34)
    by nycstray on Wed Jul 29, 2009 at 11:34:04 AM EST
    there on the public option/Medicare for All

    Sanders, maybe Franken (none / 0) (#43)
    by gyrfalcon on Wed Jul 29, 2009 at 11:41:29 AM EST
    maybe Feingold are the only ones I can ever envision voting against what the pres. wants, and we really don't know yet what Franken might or might not do in the Senate.

    Sanders for sure, as BTD says, doesn't care what Obama or anyone else says.  The others maybe, maybe not.  Teddy will not haul himself out of his sickbed to vote against Obama, but he might well not haul himself out to vote for it.


    Not too sure about Franken (none / 0) (#47)
    by MO Blue on Wed Jul 29, 2009 at 11:47:25 AM EST
    Franken's idea is to have experiments in the individual states to come up with the best plan.

    best (none / 0) (#7)
    by Capt Howdy on Wed Jul 29, 2009 at 11:08:45 AM EST
    to not bring up closets

    I'd like to see Bernie Sanders... (none / 0) (#97)
    by lambert on Wed Jul 29, 2009 at 01:58:41 PM EST
    ... do an old-fashioned, bring-the-cots-in filibuster for his single payer bill.

    I'd vote for him in 2012 if he did.


    Yeah (none / 0) (#98)
    by squeaky on Wed Jul 29, 2009 at 02:04:38 PM EST
    Most of would love than, but unfortunately it would wind up a quaint and somewhat eccentric gesture, convincing the vast majority that there are a few socialists still left in America.

    Most of Us Would Love That. (none / 0) (#99)
    by squeaky on Wed Jul 29, 2009 at 02:05:09 PM EST

    Can't know 'til you try! (none / 0) (#107)
    by lambert on Wed Jul 29, 2009 at 06:21:49 PM EST
    I mean, "In your heart you know he's right was a disaster" in 1964, and that had started to change by 1974, and in 1984 the change was complete. So...

    I Support Him 100% (none / 0) (#108)
    by squeaky on Wed Jul 29, 2009 at 06:28:24 PM EST
    And would never suggest that he not work as hard as possible for his constituents. I urge my Reps would do the same to represent me.

    devil and the deep blue sea (none / 0) (#60)
    by The Last Whimzy on Wed Jul 29, 2009 at 12:15:23 PM EST
    in the 90s the secretive approach resulted in failure.

    the more inclusive approach appears just as effective.

    although maybe there is something to be gained by saying "hey.  at least we worked with you this time to kill meaningful change."

    What do you mean, "inclusive"? (5.00 / 4) (#77)
    by lambertstrether on Wed Jul 29, 2009 at 12:41:43 PM EST
    The "little single payer advocates" have been consistently excluded and censored.

    Though granted you did say "more" inclusive.

    Too bad "progressives" can't figure out how to leverage pressure from the left. Republicans know how to do it with pressure from their right, and were successful for a long time, because of it. Oh well.


    we get to say we're a bigger tent (none / 0) (#83)
    by The Last Whimzy on Wed Jul 29, 2009 at 12:57:43 PM EST
    i ask myself sometimes at what price?

    what i mean is a republican can tell another republican "get with the program, let's all pull together and win one for the home team."

    and they're speaking each other's language even if they disagree on point.


    At what point do the costs for the services (none / 0) (#67)
    by vicndabx on Wed Jul 29, 2009 at 12:26:25 PM EST
    provided come into play?  While we can insure many more folks via a number of different mechanisms, and while we can pay for the coverage via a number of different mechanisms, when do we talk about what we are paying for?  No one wants to address the 800lb gorilla.  All this other stuff is lipstick on a pig.

    If current Medicare is the goal, (none / 0) (#91)
    by oculus on Wed Jul 29, 2009 at 01:24:34 PM EST
    how would this work?  Just read Wiki on Medicare.  % of health care costs pd. for by the taxes pd. for that purpose is rather low and projected to get lower as health care costs increase and no. of payers compared to no. of recipients gets further out of sync.  

    If Medicare was the universal health care system, (none / 0) (#100)
    by MO Blue on Wed Jul 29, 2009 at 02:27:25 PM EST
    many of the cost of care and no. of payers compared to no. of recipients would be greatly reduced or go away.

    The current Medicare insurance pool consists entirely of people 65 and older and people who are permanently disabled. It is by nature, a high risk pool. In 2008, approximately 15% of the population was on Medicare.

    If the other 85% of the population were in the Medicare system, all premiums would be paid into the same system and the pool would consist of a large number of younger, healthier people. It would no longer be a high risk pool.

    There would also be costs of scale reductions. Medical providers would no longer need to pad their charges to recover uncollected fees for services provided to people who cannot pay for them. Standard forms and filing mechanisms would also help medical providers realize processing saves which could be passed down to their customers. Just allowing Medicare to negotiate high volume discounts for drugs would produce hugh savings.


    Thank you. One question though. As (none / 0) (#101)
    by oculus on Wed Jul 29, 2009 at 02:32:13 PM EST
    I understand it, employees and employers and/or self-employed person all contribute to pay for Medicare now.  Wouldn't the amount contributed have to go up substantially to cover so many more people?

    Employers, employees and individuals (none / 0) (#104)
    by MO Blue on Wed Jul 29, 2009 at 03:40:44 PM EST
    now pay health insurance premiums to private insurance companies to provide coverage for people not eligible for Medicare. These premiums are in addition to what is paid into FISA (current Medicare funding).

    The additional people would be covered by these premiums being paid to the Medicare system rather than to the private insurance companies or by eliminating the premiums and (heaven forbid) increasing taxes on corporations and individuals. The cost of providing the coverage would be lower since profit margins and underwriting costs would be eliminated. Just consider the fact that each major insurance company has 4 or more top executive officers who make multimillion dollar annual salaries and they are charged with meeting or exceeding Wall Street expectations.

    No matter what system is adopted there will always be people who need assistance or cannot pay for their health care, a single payer system would not cost anywhere near a trillion dollars. In fact, there are estimates that it would cost less than what we currently have.


    Thanks for your thoughts. (none / 0) (#105)
    by oculus on Wed Jul 29, 2009 at 03:42:29 PM EST
    Single-payor already exists (none / 0) (#106)
    by diogenes on Wed Jul 29, 2009 at 04:49:24 PM EST
    It is called the VA system, and we know what good care they provide.

    Yes we do (5.00 / 1) (#116)
    by Steve M on Wed Jul 29, 2009 at 07:52:28 PM EST
    Patient satisfaction in the VA system is higher than patient satisfaction in the private health care system, year after year after year after year.  I completely agree with you.

    Unfortunately, some people have been fooled by anecdotal evidence pushed by those who like to demonize the VA system for ideological reasons.  Can't let people realize the government is capable of providing excellent health care, you know.


    Here we go again (none / 0) (#115)
    by NYShooter on Wed Jul 29, 2009 at 07:50:08 PM EST
    It's not "The VA," or any other agency that's bad. It's the bad people who sometimes are put into positions of authority who make the system look bad.

    I know many veterans who are getting outstanding care at VA facilities. And, I'm sure there are places where the care is less than optimal. But, it's similar to the situation with FEMA. Under Bill Clinton they did a fantastic job; just ask Jeb Bush, who had nothing but the highest praise for them after seeing their great work in eight hurricanes (2004-2005.) Later, when Bush put in "Brownie," well, we all know how that ended up.

    If our leaders want the VA to be great, it will be great.

    It's our job to make them want it.