A Reasonable Take On the Health Bills

I prefer this to "Mission Accomplished" on health care (see Cenk Ugyur warning against "Mission Accomplished" on health care):

[W]e're not done. Even if the bill does a better job than CBO projects, health-care costs will still bankrupt us. This is one small step for cost, one giant leap for coverage. My great hope is that the bill makes the next steps easier. But there's still no guarantee we'll take them. And the debate and difficulty Congress had passing a bill that was too small and deeply compromised has left me very pessimistic about our system's capacity to make harder decisions. The danger is not that we can't solve our problems, but that we won't. And that's the biggest risk of all.

From Ezra Klein. Good post.

Speaking for me only

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    I agree, good post. And certainly we are (5.00 / 1) (#1)
    by esmense on Wed Mar 24, 2010 at 04:57:31 PM EST
    far from done. But oh my, how long is it going to take to get to the next round of reform?

    Oddly enough, I was going through a rarely used drawer in my desk today looking for an old business card for a supplier and came across slides of an ad campaign for I did for Blue Cross in 1983. I was struck by how all the issues were the same -- one headline; "America, you have the world's best health care. You just need better ways to pay for it." Tag line for the campaign; "Because the times demand more choices." Ha ha. The times haven't changed, have they?

    But hey, wouldn't that have been a good approach for the Dems to take on the public option?

    Too late now. (5.00 / 1) (#2)
    by Buckeye on Wed Mar 24, 2010 at 05:29:10 PM EST
    My fear is that if this bill is a failure (hopefully it is not), the public will blame the Democrats/left.  For example, if premiums skyrocket because the mandates do not bring the cost of the regulation and 85/15 premium split down enough to lower prices.  Or if we do not get to universal care.  Or Congress fails to deliver against the assumptions given to the CBO and the deficit explodes.  Or small business dump employes on the private insurance markets at higher than forecasted levels creating dissatisfaction and an exploding debt, etc.

    If so, the public may not look to the Democratic party again for solutions (blaming them for what is wrong with health care) and we may get an even more conservative health care package.  That is in my opinion the big risk the democratic party is taking not including a public option and other popular reform measures that would have worked.  For example, even if Obamacare flops, if a strong PO was in the health care bill, a significant number of people would find refuge in the public option and the left could point to something that is working and leverage that to expand public insurance.  The public would follow that direction since it was popular and would be currently working.  We will never know.


    The market will respond with (none / 0) (#5)
    by BTAL on Wed Mar 24, 2010 at 05:57:15 PM EST
    higher premiums.  Just the items that go into effect in the next 180 days will result in higher premiums.  That will make for a very difficult time for Dems campaigning once they break for their Aug. recess.

    Don't forget (none / 0) (#7)
    by jbindc on Wed Mar 24, 2010 at 06:21:37 PM EST
    Insurance companies that raised their rates in the last couple of months - next time they need a rate hike, it will based on those higher rates, and not the rates last year when the whole health insurance bill was being talked about.

    The market already has responded. (none / 0) (#10)
    by inclusiveheart on Wed Mar 24, 2010 at 06:36:06 PM EST
    They're not done yet is what I think you probably meant.

    Yes. (none / 0) (#30)
    by Buckeye on Thu Mar 25, 2010 at 08:40:47 AM EST
    And rate increases will have happened anyway.  The problem is that rate increases from here on out will be the fault of the democratic party in the minds of many voters.

    Of course, the public will blame the Dems (none / 0) (#9)
    by bridget on Wed Mar 24, 2010 at 06:29:31 PM EST
    who delivered this business friendly Republican dream bill to the nation - the Dems who gifted the insurance companies with 30 millionen  additional clients by force

    .....  once the public finally figures out what Obamacare actually entails - and that will take some time. And the prices for anything health will go thru the roof. Nowhere are Meds as expensive as in the US today. Anyone been to the dentist lately? Just a couple examples.

    So far Obamacare is still like sausage - the ingredients are basically unknown to everyone, esp. the buyers. A Secret. Can you say politics?


    I'd for this Congress or any one of the (none / 0) (#3)
    by inclusiveheart on Wed Mar 24, 2010 at 05:35:05 PM EST
    next ten to prove me wrong, but I doubt that healthcare will be addressed with anything more than spit and glue within the next 20 years.

    Which is what they've been threatening (5.00 / 1) (#6)
    by shoephone on Wed Mar 24, 2010 at 06:12:07 PM EST
    all through this process:

    "We have to take what we can get, NOW, because we won't have the chance to revisit in for another generation!"

    Apparently, their threats to bow out unless there's a PO are meaningless, but their threats against doing the job for the rest of us are very real.


    public option anyway (none / 0) (#8)
    by diogenes on Wed Mar 24, 2010 at 06:24:02 PM EST
    Obama will invoke some populist clause to ban insurance price hikes, thus rendering it uneconomical for insurance companies to be in the health insurance business.  Once they are driven out of business, it'll be public option by default.

    You're refering to the other Obama (5.00 / 1) (#11)
    by inclusiveheart on Wed Mar 24, 2010 at 06:40:18 PM EST
    right?  The one that exists only in the minds of the devoted and not in reality.

    I'd place my bets on people like Sherrod Brown trying something along these lines, but I'd never place a bet on Obama taking up the cause and driving anything like what you describe.

    He'll make a big deal of calling the CEOs of the private insurance companies to the White House to wack their willies publicly, but there will be no force of law behind his chastisement.  It will be the same as it was with the bankers.  Just a public kabuki to make people think he really cares, but nothing more.


    Yup, that's the GOP line (5.00 / 1) (#25)
    by gyrfalcon on Wed Mar 24, 2010 at 11:32:03 PM EST
    these days, all right.  Just heard it several times today on Fox already.

    Good job!


    Fantasy (none / 0) (#13)
    by Spamlet on Wed Mar 24, 2010 at 06:52:16 PM EST
    Guess what .. I just read (none / 0) (#18)
    by bridget on Wed Mar 24, 2010 at 07:11:45 PM EST
    a German article discussing the new US Health care bill and I found out that "public option" was a very important part of Obama's candidacy for Prez in 2008. He promised health care for everyone and everything would change with hope ....  cause we are the ones we are waiting for or something like that. That can't possibly be true. The Germans must have gotten that one wrong. Sigh.  

    I willing to bet that the Dems (5.00 / 1) (#12)
    by MO Blue on Wed Mar 24, 2010 at 06:50:10 PM EST
    will sometime in the near future run and solicit campaign funds on fixing the current legislation sometime after the next election or the next or the next.

    Please give a couple examples (none / 0) (#15)
    by bridget on Wed Mar 24, 2010 at 06:58:27 PM EST
    in order to convince me - if even just a little bit - that this will happen.

    And what do campaign funds have anything to do with fixing any current legislation?


    I didn't say that they would actually (none / 0) (#19)
    by MO Blue on Wed Mar 24, 2010 at 07:18:19 PM EST
    fix the current legislation. I said they would ask for contributions promising to fix the legislation. Promises like all those Dems who promised not to vote for any bill without a public option.

    The Jobs for Progressives In Perpetuity Act (5.00 / 1) (#21)
    by lambert on Wed Mar 24, 2010 at 08:53:42 PM EST
    "Fighting for us," donchya know.

    "I'd love for..." n/t (none / 0) (#4)
    by inclusiveheart on Wed Mar 24, 2010 at 05:35:25 PM EST
    Information I didn't know about the legislation (none / 0) (#14)
    by MO Blue on Wed Mar 24, 2010 at 06:54:00 PM EST
    Sen. Ron Wyden (D-Ore.) has a message for all the attorneys general and Republican lawmakers who are threatening lawsuits and claiming that an individual mandate for insurance coverage is unconstitutional: You don't have to abide by it -- just set up your own plan.
    It's called the "Empowering States to be Innovative" amendment. And it would, quite literally, give states the right to set up their own health care system -- with or without an individual mandate or, for that matter, with or without a public option -- provided that, as Wyden puts it, "they can meet the coverage requirements of the bill." link

    Or, as they admit in their complaint, (none / 0) (#17)
    by andgarden on Wed Mar 24, 2010 at 07:09:27 PM EST
    they can simply opt out of Medicaid.

    I recall ERISA being the roadblock (none / 0) (#20)
    by Joan in VA on Wed Mar 24, 2010 at 08:07:41 PM EST
    to state single-payer, which was under discussion last year. Would that not be a problem with this? I am not at all knowledgeable about ERISA regs but I have read some complaints lately that HCR didn't address the issue.

    You're right, it didn't (none / 0) (#26)
    by gyrfalcon on Wed Mar 24, 2010 at 11:36:08 PM EST
    but Wyden's language would appear to allow states to do their own thing other than single-payer.

    And let's be clear, the states that would want to opt out would overwhelmingly be winger-dominated states, and the last thing they'd want to do is single-payer.


    There's another problem with it (none / 0) (#22)
    by Catesby on Wed Mar 24, 2010 at 09:09:16 PM EST
    aside from telling the States they must kick in money.

    It is the exclusion in the Constitution on capitation taxes unless apportioned to the States by the census.

    Now, there have been so many things flying about the tubes on whether the mandate penalty is a fixed amount, a percentage of income, or a hybrid, but if there is any fixed amount it would seem to fly in the face against the Constitution restriction on capitation taxes.

    So the States could argue that the Feds are usurping their rights to collect and pass on these taxes.


    Haven't heard any of the (5.00 / 2) (#27)
    by gyrfalcon on Wed Mar 24, 2010 at 11:37:40 PM EST
    GOPers AGs talking about this, though.  I honestly think they're less interested in actually challenging the bill than in demagoguing for political advantage, which is why they're almost single-mindedly focusing on the individual mandate and the Medicaid expansion requirement.

    Yeah. You should (none / 0) (#16)
    by Mike Pridmore on Wed Mar 24, 2010 at 07:01:20 PM EST
    see what the true believers at dKos had to say about the same diary by Cenk.  Very ugly.

    I love this and can't wait to see if it passes (none / 0) (#23)
    by Bornagaindem on Wed Mar 24, 2010 at 09:29:51 PM EST
    It seems the Hill staffers that wrote the awesome health care bill want to be exempt from it. I hope the repugs make a huge deal out of this and make ALL congressmen, senators, staffers, cabinet members and even the president have to get their healthcare through the "exchanges" instead of their current cozy deal. And I want to make it that way  even once they retire (especially for Obama since he plans on being gone before the $hit hits the fan). If Grassley succeeds in shaming them into doing this and then making public how much they pay and are compensated for their healthcare plans we could luck out and get real reform. I guarantee you they will fix this crappy bill if they have to get their family insurance this way. It is what is called incentive.

    From Politico

    Tonight, as the Senate moved toward the process of debating the reconciliation bill, Grassley offered yet another amendment to force all congressional staffers, as well as the president, vice president, cabinet members and top White House staff to buy coverage through the exchanges.

    "The new health care law creates two double standards. The congressional staff who wrote the new law exempted themselves from the new health care system, while other staff will be in it," Grassley said today in a statement. "And, President Obama himself will not live under Obama health care. The message to grassroots America is that it's good enough for you, but not for us."

    Grassley lost (5.00 / 2) (#28)
    by gyrfalcon on Wed Mar 24, 2010 at 11:40:09 PM EST
    and odds are really very high that the failure to word the Dem. bill so as to include committee staffers was inadvertent.

    All Congresspeople and their direct staffers are required to use the exchanges, and Obama has said he'll use it for himself and his family (if he's still in office by then, of course.)



    gee and you are surprised? (none / 0) (#31)
    by Bornagaindem on Fri Mar 26, 2010 at 06:55:32 AM EST
    It wasn't inadvertent since Grassley has been pointing this  out since last December. Also as Grassley said he appreciated the president's action but believes participation in the new health care plan should not be on a voluntary basis.

    Hopefully this will be introduced as bill from now on. It makes a great issue one the republicans would do well to exploit. Make Congress, the White House and the Supreme Court get their insurance from the "exchanges". They will no longer have the advantage of the bargaining power of the federal employees Health benefits program.

    Watch the news -when this goes out of the public eye it will be changed all right but changed so members will be back in the FEHBP and not in the exchanges.


    hmmmm.... (none / 0) (#24)
    by ZtoA on Wed Mar 24, 2010 at 09:30:23 PM EST
    I usually feel so inadequate in these discussions. And it is really that I cannot clearly see the future and am having difficulty predicting it. IF this is the final say on health care reform -then- I think it is a very very bad bill and a horrible failure. IF the young people of today think that the door has opened to more changes in, say 15-25 years (hey, what's a few decades to them) -then- this bill will have great merits of door opening. But what is the future to bring? More of the same? Do we have the luxury to gamble on the next few decades? We really don't know for sure.

    There's an interesting article in "Foreign Affairs", titled 'Decline and Fall' by Niall Ferguson (a well written piece, needed to be said, but also....sort of self evident)  which basically says that manifest/visible change happens quickly - like a stock market crash. The reasons for the crash have been there and building for a long time, but the manifest/visible results and 'change' happen fast. So the idea is that people act on underlying forces for whatever change is happening at some point in time. In that case then 'media appeal' and media attention is an indicator.

    I find the whole "most progressive piece of legislation since FDR" meme a bunch of BS. What about civil rights? That happened. And it rearranged the legacy parties. The teapartiers (aka teabaggers) are some former dem constituents).

    You're not alone (5.00 / 2) (#29)
    by gyrfalcon on Wed Mar 24, 2010 at 11:45:46 PM EST
    Nobody can see the future and how this will sort itself out over time.  And as with all ground-breaking legislation (good or bad), whether it gets fixed or not in the future depends on who's in charge when the need for the fix becomes apparent.

    I don't like this bill and I hope it does get revisited.  But it's also a fact that the alternative to plunging in and accepting the massive uncertainties of the future is either tiny incremental change, which is the GOP line right now, or complete paralysis.