Should Progressives Defend A Mandate Without A Public Insurance Option?

In a piece that provides broadstroke background on the legal issue surrounding the challenges to the health bill, Jonathan Cohn spends the lion's share oh his argument on the individual mandate.

Like Cohn, I find the arguments for the unconstitutionality of the mandate "unpersuasive," to say the least. But I wonder if this is a fight a progressive wants to have. Cohn asks:

What would an unfavorable ruling mean for the future of health care in the United States? The best case scenario, at least for those of us who support the Affordable Care Act, is that the government finds another way to impose the mandate or enact a modification that achieves close to the same ends.

But itís unclear how well such measures would work. And any solution would require the enactment of new legislation, something that might be difficult in the political aftermath of an unfavorable Supreme Court decision. In the absence of remedial action, the Affordable Care Act could falter, the regulatory and financing apparatus coming apart as premiums rose and insurers chafed under requirements they could not realistically meet. Itís easy to imagine a scenario where, rather than deal with the mess, a chastened Congress throws up its hands and decides just to repeal, or at least severely claw back, the entire universal coverage plan.

This is "unpersuasive" to me as well. If "universality" is dependent on a requirement to purchase private health insurance, rather than the offer of public health insurance (this is where the public option/Medicare Buy-In comes in), then there is something wrong with your mousetrap, and there always was. The scenarios Cohn finds "easy to imagine" were easy to imagine prior to passage of the health bill. That is why some of us argued for "autoenrollment" in a public insurance program (in the manner that Medicare works) as the universality mechanism instead of a mandate. Cohn continues:

On the left, some have wondered whether this might finally create a groundswell for single-payerĖstyle health insuranceówhich, like Medicare, would clearly fall under the governmentís taxing power and therefore be constitutionally invulnerable. Thatís possible. But itís just as possible that the country would simply give up on universal health care, at least for now, effectively deciding that guaranteeing affordable access to medical care was something the United States, alone among developed countries, could not do.

No, that really does not seem "just as possible." For progressives, at least those who believe the failure to include a public insurance program in the health bill was a terrible mistake, there is little incentive to support the mandate as is.

Remember that the truly progressive part of the bill is not in any way connected to the mandate - the expansion of Medicaid coverage. For some of us, the loss of the exchanges (because it won't work without a mandate) is no loss at all.

In addition, the loss of the mandate does not threaten the regulatory parts of the health bill.

The reality is the only group threatened by the loss of the mandate is the insurance companies (and the wonks who like the exchanges.) And in the end, that is what will save the individual mandate. The Supreme Court won't hurt the insurance companies.

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    Total agreement on this (5.00 / 1) (#1)
    by MO Blue on Wed Jan 19, 2011 at 01:00:29 PM EST
    The reality is the only group threatened by the loss of the mandate is the insurance companies (and the wonks who like the exchanges.) And in the end, that is what will save the individual mandate. The Supreme Court won't hurt the insurance companies.

    Universality is not part of the current legislation. Millions will continue to go without health insurance and millions more will IMO go without health care due to the cost of actual care.

    While I agree that the mandates will remain, the most vulnerable part of the legislation is the the expansion of Medicaid coverage. That IMO will be the first thing that will be cut or bargained away.  

    agreed (none / 0) (#6)
    by Dadler on Wed Jan 19, 2011 at 02:11:30 PM EST
    when you are guaranteed a huge captive market, jeebus, no way you're letting that go.  crumbs for the rabble, those "we" can afford to get rid of.  

    The subsidies, too are vulnerable. (none / 0) (#11)
    by inclusiveheart on Wed Jan 19, 2011 at 02:47:12 PM EST
    Those could easily be defunded by the GOP without much consequence while they allow the mandate to stand.

    I always thought that if the bill were well written - and it is not as far as I can tell - that things like the subsidies and the mandate would be inextricably linked - without one you could not have the other.


    "Progressives" shouldn't have (5.00 / 5) (#8)
    by Anne on Wed Jan 19, 2011 at 02:14:35 PM EST
    accepted it the first time around, but they let themselves be bullied into single-payer coming off the table from the get-go, and then let themselves be distracted by what only ever amounted to a bumper sticker: the "public option."

    So, I pretty much think that no one on Capitol Hill or the White House is shaking in his or her shoes about any fuss "progressives" might make over the mandate.

    The country has yet to even have an informed discussion about what real universal CARE would look like; they don't even understand - the example of Medicare notwithstanding - what single-payer is, and how it would work for them.  Or how beneficial it would be to the economy.  Can you give up on universal care if you never tried to put together a universal plan?  That this is what has happened may make perfect sense to the president who promised "Yes, We Can," but prefaced everything with "Well, No We Really Can't," but I still don't get it.  I do understand that it's unrealistic to expect to get everything we want, but is it unreasonable to expect at least a good-faith effort to go for all the marbles?

    Apparently it is.  It's unreasonable to want someone to really work on one's behalf, and it's just rude to be so ungrateful for the meager crumbs cast our way after the bread was given to those already swimming in it.

    But leave it to Dems to allow someone else to determine what the fight would look like, what would be on or off the table, and to make sure to let their representatives knew that no matter how badly it all turned out, they would not abandon them at the polls.  

    I don't think it matters one whit what I want, or what you want or what anyone wants; what matters is who has the money and power to keep funding the Protection and Mutual Admiration Society that the presidency and Congress have devolved into: Corporations Win, People Lose.  

    So, for now, the beatings will continue until morale improves.

    The individual mandate means the end (5.00 / 1) (#27)
    by Bornagaindem on Wed Jan 19, 2011 at 04:56:25 PM EST
    of employer subsidized insurance and the beginning of a cost spiral upwards that will have politicians running for the hills. Private insurance companies are already jacking up prices unbelievably and the idea that they will be stopped by the requirement they spend 85% on healthcare means they will find themselves some very crooked/corrupt bookkeepers right quick. Since it is an individual mandate employers will stop  funding insurance and realize a huge windfall because the fines are miniscule compared to the cost of providing health insurance. Hold onto your horses baby because it is going to get a lot worse. And who will they blame?- the democrats. Thank you for the bestest president evah!

    It Is Easy (5.00 / 1) (#28)
    by AngryBlackGuy on Wed Jan 19, 2011 at 05:28:45 PM EST
    to blast the healthcare legislation when your default assumptions are:

    (a) Everything positive will not deliver as promised, and

    (b) The things that will work will be bargained away (despite the fact that there is no need to bargain anything away and it is not going to happen).

    The test is whether, a year from now, when nothing is bargained away and the nation prepares for 2014, whether the assumptions made here will be revised or whether a different reason to doubt the legislation will be found.

    People are just so confident that provisions will be stripped and it's completely unfounded.  The only way that could happen is a finding of unconstitutionality, which is highly unlikely.

    Are you self-insured? (none / 0) (#36)
    by shoephone on Wed Jan 19, 2011 at 06:40:20 PM EST
    If so, I'd love to know how you are able to afford the premiums. Maybe you're rich; most of us aren't. In my state -- Washington -- Blue Shield has jacked up self-insurance premiums for individuals roughly 30% since the health insurance reform bill was signed into law. We've got three more years until the law actually goes into full effect. That gives them three more years of jacking up prices. Oh joy. Face reality please.

    My guess is you're not self-insured. You either get health insurance benefits through an employer, or you get to be on mom's plan. Talk to me when you are running a business and self-insuring. And over 50 years old.


    Actually (5.00 / 1) (#41)
    by AngryBlackGuy on Wed Jan 19, 2011 at 08:30:50 PM EST
    I buy insurance with absolutely no subsidies and it is ridiculously expensive.

    And if my premiums stay exactly where they are or increase slightly, 35 million americans with coverage is my primary concern and I'll accept that.

    For some of us, helping the masses takes first priority and 35 million new people with coverage means something.


    You don't get it, do you? (none / 0) (#50)
    by shoephone on Wed Jan 19, 2011 at 11:17:02 PM EST
    There are millions of people in this country who must self-insure who don't qualify as "poor" -- who won't be qualifying for subsidies either. They will be left out of the game.

    Honestly, I don't know why I waste my time responding to you. Stark realities don't seem to register with you.

    I'm done wasting my time.


    I completely understand (2.00 / 0) (#51)
    by AngryBlackGuy on Thu Jan 20, 2011 at 06:33:22 AM EST
    What you seem to be saying is that because people who self insure (and are subject to increasing premiums) won't have those premiums addressed, we shouldn't take count of the 35 million without healthcare coverage right now who will have healthcare coverage because of this bill.

    This program was never sold as a fix to every problem, and the fact that it can't fix everyroblem does not mean it is not a good piece of law.

    The self insured's premiums will go up under no plan and they'l go up under the reformed structure, but that doesn't mean the new structure is not a net positive for the country.

    I reject all claims that we shouldn't have done it simply because it didn't solve every single problem we have on healthcare.

    The stark reality not being registered by you is that of the 35 million people this law will benefit.

    Feel free to stop addressing me all you'd like, but it is sad that our disagreement about fundamental assumptions is something you can't handle in the spirit of a good faith debate on the issues.


    You are making one of the most (5.00 / 2) (#52)
    by Anne on Thu Jan 20, 2011 at 07:09:55 AM EST
    flawed assumptions about this legislation: that 35 million people will benefit from it.

    First of all, why are you using the number 35 million when it is believed that there are over 50 million people without insurance?

    Second, you still seem to not understand that having insurance does not guarantee care.

    Third, there were no cost controls of any kind built into this legislation.  That means that even though you and I and everyone else will be required to have insurance, the insurance companies are not limited in what they can charge to provide it.  They are required to cover you if you have a pre-existing condition, but they aren't required to charge/rate you as if you didn't.  They are required to insure your child until he or she is 26, but they don't have to add that person to the existing policy - they can make you start over with a new policy, which usually costs more and covers less.  

    And, as shoephone pointed out, what of the people who aren't poor enough to qualify for subsidies or Medicaid and don't make enough to afford the least expensive plan?  And who are going to be fined in some way as a result?  What is your answer to them?

    Fourth, no one is saying we shouldn't have done it; what people are saying is that this was not the way to do it, this was not the way to structure it, that the way it was done and the way it was structured is not solving anything, that if there's a crisis in care, it makes no sense to make people wait four years for relief - and leave in charge the very industry that got us to this point.

    Fifth, the reason people are disagreeing with you over "fundamental assumptions" is that the ones you are coming to the table with are pretty much just wrong, which skews everything that flows from them.

    Finally, if there is one thing - just one - that takes most of your assumptions and makes a joke out of them, it is this: insurance is not care.  I would repeat that as often as you need to until you get it: insurance is not care.

    Insurance companies are gatekeepers who extract thousands of dollars from people before those people ever incur one dollar of charges for actual care.  

    Insurance is not care; try coming to grips with that fundamental truth, and then let's have that honest debate you want.


    Might want to ask him (none / 0) (#38)
    by MO Blue on Wed Jan 19, 2011 at 07:04:57 PM EST
    if he is a government employee. He made comments earlier about having government regulations on his selves.

    If the loss of the mandate does not (5.00 / 0) (#39)
    by Militarytracy on Wed Jan 19, 2011 at 07:13:26 PM EST
    affect the regulatory parts of the bill....then no...progressives should not waste their time fighting for the mandates if a public option isn't included.

    In a word, yes. (none / 0) (#2)
    by vicndabx on Wed Jan 19, 2011 at 01:36:27 PM EST
    For reasons Cohn explains.  

    You think it is "just as possible" (none / 0) (#5)
    by Big Tent Democrat on Wed Jan 19, 2011 at 02:04:56 PM EST
    that the country will gve up on universality? Or because the exchange framework would be damaged? Or both?

    Both, and other reasons as well. (none / 0) (#9)
    by vicndabx on Wed Jan 19, 2011 at 02:36:18 PM EST
    My gut tells me, we don't care enough about one another in this country, and, are more often than not, out for self.  Universality in this form, still gives those who are dead set against it the ability to "opt out," albeit thru some minor tax penalty.  IMO, in order for some alternative like a Medicare buy-in to succeed, too many would have to give something up - I don't think we have the stomach for that yet.  

    .....and yes, the ability to provide the funding for those who could take advantage of the exchanges would be damaged.

    Further, andgarden touches on the political optics of a major rollback on the law.  He's absolutely right, Dems have spent a bunch of capital on this, why should we blow all that to try for a second, undoubtedly much smaller bite at the apple?  Most folks are happy w/the coverage they have (if they have it.)  
    On this issue, support from the flank should not have to be the President's or Dems focus.  We have an economy to try to rebuid.


    I don't care about the exchanges (5.00 / 1) (#10)
    by Big Tent Democrat on Wed Jan 19, 2011 at 02:43:09 PM EST
    I do not think they will work at all, with or without a mandate, though they definitely will not work without one.

    I'm prepared to accept the failure of exchanges so that real solutions can be back on the table.

    In short, the only thing I really care about in the health bill is Medicaid expansion.


    Hence, your apparent bias :-) (none / 0) (#12)
    by vicndabx on Wed Jan 19, 2011 at 02:53:43 PM EST
    I will say, and this is no knock on you, the rationale "the only thing I really care about in the bill...." is why it's best to leave well enough alone for now.  Too many others have constituents that feel the same way - about some other piece of the bill.

    The prescription drug exchanges (after some initial hiccups) work quite well for many.  My own experiences have been suprisingly good when I used them for eligible family members.  It is a good example of the so-called "third way" actually working.


    Prescription drug exchanges (none / 0) (#14)
    by Big Tent Democrat on Wed Jan 19, 2011 at 03:02:50 PM EST
    Are you talking about the 2003 Bush prescription drug benefits law? If you are, then you should know it works well because it costs a fortune.

    In terms of cost containment, it is a disaster, and is unsustainable.


    Cost containment (none / 0) (#23)
    by vicndabx on Wed Jan 19, 2011 at 03:49:15 PM EST
    indeed it is a disaster - and for reasons which I'm sure were in part political, Dems wanted to load it up even more back in 2003.  Which is not a bad thing - seniors who need it should get help w/drug costs.

    Point here is again though, w/o containment on the cost of the product, we are merely moving deck chairs around on the Titanic.


    For federal government employees (none / 0) (#42)
    by christinep on Wed Jan 19, 2011 at 08:35:10 PM EST
    the exchanges concept actually has worked. Of course, the question is whether this much broader challenge==with so many millions more--can be met with exchanges. With some trepidation, I'd say "yes."

    I am inclined to side with Cohn (none / 0) (#3)
    by andgarden on Wed Jan 19, 2011 at 01:40:36 PM EST
    if only because the Commerce Clause is plainly worthy of defense.

    I remain thoroughly unconvinced that the ACA's scheme will achieve the goals we care about, but it was so effing expensive to pass (politically) that I would rather give it a chance to prove itself.

    Honestly, it doesn't look good (5.00 / 2) (#13)
    by inclusiveheart on Wed Jan 19, 2011 at 02:56:43 PM EST
    for the ACA now and the implementation is only going to make the problem worse when people find out that they are mandated to pay hugely expensive premiums that seem to have no check or balance applied to them in this bill.  California's Blue Shield announced a 59% rate hike for this year.  What' next year and the year after that going to bring us?  What will premium prices look like in 2013?  Even in 2012, they could be good and scary.

    The truth is that we are still hearing the same sob stories about healthcare that we were before they passed this bill.  And the same old themes of the sob stories are not going away even after this bill is enacted.  Those key sob stories are - people who are really sick can't afford health insurance - sure now they can buy it but they are still priced out of the market in many cases.  People who have pre-existing conditions - same thing.  People who are just people in the average categories - the other 60% of Americans who do not have pre-existing conditions are still getting hit with huge rate hikes - and providers are still battling to get paid for legitimate claims.  The bill doesn't really do anything to address these problems.  So, I think that the Democrats really should be quite worried about the time when the full implementation takes effect because people's problems will not have been solved and the Democrats are going to look really stupid for having pretended they've really helped at all.


    How on earth (none / 0) (#43)
    by AngryBlackGuy on Wed Jan 19, 2011 at 08:37:37 PM EST
    do you know that.

    This is the most infuriating part of all.

    You have absolutely no idea whether your predictions are accurate. None. Zero. In fact, the examples we have indicate that the exchanges and other tactics will work as planned.

    2014 people. At least wait until the thing starts before claiming confidently to know how it will end.


    No AngryBlackGuy, I don't (5.00 / 0) (#46)
    by inclusiveheart on Wed Jan 19, 2011 at 09:09:56 PM EST
    know anything except for the twenty years experience that I have in the healthcare industry.  Except for that, I don't know anything at all about what's going to happen with this law.

    We do know how one part of this (5.00 / 0) (#47)
    by MO Blue on Wed Jan 19, 2011 at 09:22:19 PM EST
    legislation is working. To date, the government high risk pool is pretty much of a dud. Much too expense for the average person. IIRC, only 8,000 people have signed up for the program nationwide.

    Let's use MA as an example of some of the problems that exist with the exchanges:

    In March 2009-two months before Gruber wrote this paper-MA released the first results [PPT] of how that state's health care reform had improved access. It showed that 21% of the total population-and even 12% of children-forgo necessary medical care because they cannot afford it. Of the 21% forgoing care, most (something like 18 or 19%) have health insurance-but it is health insurance they can't afford to use. In a paper contemplating what constitutes affordability for a national plan that resembles the MA plan in many ways, Gruber uses national Kaiser/HRET data, rather than the MA data that is much more directly on point. link

    Well we might ask you the same thing... (5.00 / 0) (#48)
    by Anne on Wed Jan 19, 2011 at 09:24:02 PM EST
    how do you know how this is going to turn out?  What examples are you referring to that forecast great success for this legislation?  Can you at least point to some to back up your own prognostications?

    The fact that premiums are continuing to rise, that insurance companies are continuing to play all the angles in their effort to maximize profits, that there are more people without insurance than ever, means that those of us who are less optimistic about the chances the legislation will actually expand access and affordability of care are not just pulling these opinions out of thin air.

    And, I'm sorry, but you can't ask others to wait before venturing any opinions without doing the same yourself.


    Commerce Clause (none / 0) (#4)
    by Big Tent Democrat on Wed Jan 19, 2011 at 02:03:43 PM EST
    is not, in reality, in play here. 3 kooky district court de facto advisory opinions do not put it in play imo.

    Call me when a circuit court decides a mandate is unconstiutional. Not gonna happen.


    BTD (none / 0) (#31)
    by DaveCal on Wed Jan 19, 2011 at 06:02:04 PM EST
    I have to ask.  If the federal government can use the commerce clause to mandate that every citizen buy a product or service from a private supplier (like mandating that we buy health insurance from an insurance company), then what product or service would they NOT be able to force us to buy?  

    Regardless what you think of the necessity/usefulness/"rightness" of such a policy, I see no limits to the power of the federal government to control our lives if this is upheld.  That's NOT the limited federal government we provided for in the constitution.

    Don't you find it the least bit ironic that under the guise of "regulating commerce between the states", we who are not otherwise engaging in this form of commerce will be forced to start engaging in this form of commerce and the product we are mandated to purchase is a product that, at least in a number of states, we cannot legally purchase across state lines?    


    There's reason to be afraid (none / 0) (#32)
    by andgarden on Wed Jan 19, 2011 at 06:13:39 PM EST
    of a law requiring, e.g., Jews to buy pork. But a law requiring everyone to buy something isn't not a concern per se. I mean, if it's so objectionable a requirement, vote for someone else and repeal the requirement.

    Already did the vote thing (none / 0) (#35)
    by DaveCal on Wed Jan 19, 2011 at 06:31:07 PM EST
    And it's a concern "per se" because its an issue of control, or oppression.  

    What happens when the federal government mandates that we all buy handguns because they think it'll reduce crime with a deterrent effect?  

    Or when we're told what food we can purchase (and what we cannot) because what we eat affects our health costs, or farming industries in general?

    Or when we're required to send our kids to public schools since the school system might go bankrupt without mandatory attendance?  


    Is the Home Buyer Tax Credit (none / 0) (#37)
    by andgarden on Wed Jan 19, 2011 at 06:46:55 PM EST
    an "issue of control, or oppression"? How about the fact that you are required to pay taxes that fund public schools whether or not your children attend?

    Moreover, would you be less concerned about the individual mandate if it were enacted by states instead of Congress?

    For someone so exorcised about the potential repercussions of a particular provision of the ACA, you seem remarkably unaware of the context of the issue.


    Unaware of the context? (2.00 / 1) (#55)
    by DaveCal on Thu Jan 20, 2011 at 05:12:08 PM EST
    I understand the context just fine.  Thank you very much.  

    If you have a different opinion, that's fine.  But please don't tell me I'm uninformed or unaware of context.  

    Taxes and tax credits are different issues.  If you don't know that then you are the one who is unaware.  

    Had the government enacted a tax to pay for a federal healthcare initiative, I would see no constitutional issue.  But our congressmen and congresswomen didn't do that.  Most likely because they knew they couldn't get it passed.    

    Instead, they passed a bill claiming to regulate commerce.  Sorry, I do see a constitutional issue there.  

    Interestingly, the government lawyers are now claiming in the federal lawsuits that it IS a tax.  They're not winning that argument, and rightfully so.  


    The only credible way (none / 0) (#56)
    by andgarden on Thu Jan 20, 2011 at 05:39:58 PM EST
    to claim that they are "not winning that argument" is to ignore the fact that in at least one case they won, the judge didn't even bother to reach the tax issue.

    The same scheme could have been changed in name but not form and have been a tax. Heck, the IRS is still responsible for collecting the penalty. It is simply not credible for you to claim that the great constitutional import of this issue is that Congress called it something other than a tax. As Jack Balkin has said, it reduces Constitutional law to "Simon Says."


    Should Progressives Defend A Mandate (none / 0) (#7)
    by Abdul Abulbul Amir on Wed Jan 19, 2011 at 02:13:52 PM EST

    Politically, I hope they all do.  

    let progressives (none / 0) (#15)
    by jeffinalabama on Wed Jan 19, 2011 at 03:09:37 PM EST
    shoot their ramrods supporting the law. This liberal supports Medicare for all.

    Have I mentioned (5.00 / 1) (#16)
    by Anne on Wed Jan 19, 2011 at 03:22:59 PM EST
    how little respect I have for the weenies who couldn't - and still don't - stand up for the word "liberal?"

    Enhanced Medicare for All is, in my opinion, the way to go, but as long as our representatives allow the industry to maintain its stranglehold on us, it has little chance of happening.

    And, as near as I can tell, the "Affordable" Care Act has done little but further entrench the insurance industry and guarantee it the pre-emptive windfall from raising premiums for those of us "lucky" enough to have insurance, as a way to set a much higher baseline rates for the windfall they will receive when they inherit close to (or maybe more than, by the time all is said and done) 60 million new subscribers.

    Some days I yearn to be able to go off the grid and shed myself of these vampire squid and those who enable it all.


    In defense of "weenies" (5.00 / 1) (#17)
    by Big Tent Democrat on Wed Jan 19, 2011 at 03:33:34 PM EST
    Some of us do not stand up for "liberal" because we are not liberal.

    If you're not a liberal, I wouldn't expect (5.00 / 1) (#20)
    by Anne on Wed Jan 19, 2011 at 03:44:15 PM EST
    you to defend the term; no offense intended.

    Maybe those who were content to take on "progressive" as a label were never liberals to begin with.

    Some genius decided that "liberal" was too scary and went to the less frightening "progressive" as a way of, I don't know, fooling people into thinking the Democratic party didn't have liberals in it anymore.  And then seemed to have done their best to shoo us away lest they continue to be tainted by our very presence.

    I know you identify as a centrist, but the problem is that the center of today is not the center of even five years ago - so are you a centrist no matter where the center is?

    Call me a liberal, call me a DFH or a socialist - but don't call me a progressive; I know what I believe in and stand for and it isn't this wishy-washy, personality-based, cultish thing called progressivism.

    Did not mean to offend - just have no patience with those who think progressive is an adequate substitute for liberal; it isn't.


    No offense (5.00 / 2) (#21)
    by Big Tent Democrat on Wed Jan 19, 2011 at 03:46:51 PM EST
    You may have read my reasoning for adopting a meaningless label - Centrist - before.

    It is because "The Center" is where you want to be in politics.

    But instead of running to what is perceived as the Center, I define my views as the Center and place everyone around me.

    Sun revolves around me type of thing.


    Galileo proved you wrong :) (5.00 / 1) (#34)
    by Dr Molly on Wed Jan 19, 2011 at 06:25:36 PM EST
    But instead of running to what is perceived as the Center, I define my views as the Center and place everyone around me.

    Sun revolves around me type of thing.

    You're pretty liberal on some (5.00 / 1) (#22)
    by inclusiveheart on Wed Jan 19, 2011 at 03:47:32 PM EST

    Ithink 'progressive' (none / 0) (#24)
    by jeffinalabama on Wed Jan 19, 2011 at 03:51:42 PM EST
    is a moveable famine. BTD, Anne, I know or think I know where each of you stands. Just by standing for something removes the 'progressive' label to me.

    A label like progressive to me (5.00 / 1) (#26)
    by inclusiveheart on Wed Jan 19, 2011 at 04:46:37 PM EST
    is something akin to being "changey" - a moveable famine is exactly what it is - or maybe it is an imaginary feast - meaning that the term change was brilliantly played by the Obama camp because change can mean anything to anyone - it can be radical, passive, incremental, liberal, conservative, etc.  It is the perfect concept for personal projection and therefore a great campaign battle cry - "Change!"  Of course, me, I kept asking the TVee, "But what kind of change do you mean exactly?"

    For me, Bush was plenty changey.  Radical and changey.  I could do without that kind of change.  


    The problem with all labels (none / 0) (#54)
    by jbindc on Thu Jan 20, 2011 at 10:18:48 AM EST
    is that they are moveable.  Some people I know and have heard speak (or read) who describe themselves as "conservative" are not really conservative on all issues - especially when you talk to them about specific issues.  My mother, for instance, for years, was staunchly "pro-life", while being very liberal on other issues.  Until we had a conversation one day about what being "pro-life" meant - she believes in sex education, more access to birth control and while she believes abortion is wrong and immoral, she thinks it should not be legislated.  I finally pointed out to her that her position was "pro-choice".

    I also can say that I've met, or read, or heard people who self-describe as "liberal" who are some of the most closed-minded people I have ever encountered. They don't want to hear opposing viewpoints or facts that contradict what they believe, because those viewpoints or facts, are of course, wrong. Take the subject of religion for instance.  Most people in this country identify with some religion or higher power.  They keep it to themselves or work within their community, yet I've heard many a "liberal" make comments about how all such people are stupid and ignorant and uninformed hicks.

    Also consider the fact that your definition of "left", "right", and "center" are different than someone else's, so trying to pin a label on your neighbor really isn't that easy (and probably isn't correct).

    Especially as liberals are supposed to eschew labels for people.


    BTD, I don't think (none / 0) (#19)
    by jeffinalabama on Wed Jan 19, 2011 at 03:35:56 PM EST
    Anne's comment was directed toward you. You aren't a 'liberal,' but you have meaning. You're not just the latest brand name.

    Anne, I feel that (none / 0) (#18)
    by jeffinalabama on Wed Jan 19, 2011 at 03:33:36 PM EST
    off the grid twinge a lot lately. I keep thinking, though, "for the good of the voiceless."

    Sometimes it works. Keep fighting the good fight. I've got the southern flank covered, with allies.


    If you were a person (none / 0) (#29)
    by AngryBlackGuy on Wed Jan 19, 2011 at 05:33:23 PM EST
    who would die without the legislation just passed, I wonder whether you'd be willing to sacrifice your life for the less than 10% chance that we could somehow pass a public option.

    If I am one of the thousands of people whose lives will be saved as a result of the legislation, I am going with "no".

    And let's be clear here, we will have a nice little statistic at the end of the first year that fairly says [__] lives were saved as a result of the legislation.  Real people. Real lives.

    It's easy to argue against incrementalism when it's all this amorphous concept.

    It will be much different when you have people actively saying, loudly, I am alive because of HCR.

    I think a lot of the bold words you hear now are going to sound odd if used after 2014.


    Having the right to health insurance (5.00 / 2) (#30)
    by Anne on Wed Jan 19, 2011 at 05:58:23 PM EST
    is not the same as the right to care, and while there are many people who have had the doors to health insurance opened for them - and that's a good thing - there is yet another door or two they have to pass through before any lives are saved.  There is the door that doesn't open until the premiums are paid, and then there's the door that doesn't open unless one can afford the co-pays and deductibles.

    I have health insurance for myself and my daughter (my husband is fully covered through the VA); I pay almost $800/month and have an $800 deductible to meet, so I have to pay out over $10,000 before the first dollar of the cost of actual care is covered.  I can afford that, but millions cannot.

    This is why more people than ever before do not have insurance, even if now they have the right to be covered where they might not have been before.  And if you cannot afford it, it isn't saving your life.

    You've mentioned that your brother has coverage now because he can stay on your mother's insurance, but what if your mother couldn't afford it, and she made too much to qualify for the expanded Medicaid?  How would this legislation be saving him?

    As for the "public option," I truly wish people would stop using that phrase, as it is utterly without meaning now, and was wholly without meaning back when everyone was "fighting" for it.  It was a bumper sticker, and those never saved any lives, either.

    My point was - and I thought it was pretty clear - that if there a time when "progressives" should have refused to settle, it was back when Obama decided that single-payer was not going to be part of the discussion.  He should not have gotten to decide that, not when the health - physical, mental and financial - of millions of people was at stake.  

    We never had a chance, ABG; that die was cast long ago, and only those with their eyes closed didn't see that.

    There simply is no reason why all of us cannot and should not have access to care that we can afford, and no reason why all of our health care decisions have to be funneled through the insurance industry monolith.  Well, except for the fact that there is hardly anyone in Washington willing to send the insurance industry and their greed packing, so that we can get on with the business of reducing costs and improving the economy.

    Any life saved is a good thing, but it's terribly sad to consider that the powers that be have chosen to go with the plan that will save fewer lives and less money.  But, golly, it's going to make a lot of money for insurance companies, and Wall Street will be happy, and that's apparently the metric by which too much is measured by those responsible for legislation and policy.

    If there is anything left of the ACA by 2014 - anything good, that is - I will be shocked.


    Since we are playing "what ifs" (5.00 / 1) (#33)
    by MO Blue on Wed Jan 19, 2011 at 06:23:25 PM EST
    If you are a person who will die because the legislation just passed does not go into effect until 2014, I wonder whether you'd be willing to sacrifice your life for this POS legislation. Think that people who need actual health care now are real people with real lives.

    If you are a person who will die because you can not afford the premiums and/or the deductibles and co-pays that come with the POS legislation just passed, I wonder whether you'd be willing to sacrifice your life because politicians want to keep their contributions from the insurance and medical industries.  Think that people who need actual health care and not insurance are real people with real lives.  


    Fair Point (none / 0) (#44)
    by AngryBlackGuy on Wed Jan 19, 2011 at 08:40:42 PM EST
    People are dying because we did not implement this immediately.

    That is a moral burden that all of us shoulder.  If we could implement the act provisions today, I say do it.


    "Less than 10% chance ..." (5.00 / 1) (#40)
    by Yman on Wed Jan 19, 2011 at 08:04:42 PM EST
    ... we could somehow pass a public option".

    And let's be clear here, we will have a nice little statistic at the end of the first year that fairly says [__] lives were saved as a result of the legislation.  Real people. Real lives.

    As opposed to imaginary people and imaginary lives?  Why the sudden urge to delve into the realm of reality?  After all, the "less than 10% chance" is just fantasy, as is the "[ ] lives saved by the legislation" (hence, the "blank").

    But I guess it is easier to try to argue a point when you can just make up your own facts.


    Yman (none / 0) (#45)
    by AngryBlackGuy on Wed Jan 19, 2011 at 08:42:53 PM EST
    I was being generous.

    I believe we had no real chance of passing a public option.

    I just didn't want to get into that argument.  All of this public option talk is fantasy IMHO.  It will happen eventually and this is the start of it.

    It was not going to happen in 2010 in this political environment.


    Only my opinion obviously, but that drives my position.


    Once Obama made a back room (5.00 / 1) (#49)
    by MO Blue on Wed Jan 19, 2011 at 09:38:25 PM EST
    deal with the medical industry in the summer of 09 to prohibit any public option there was zero percent chance of one being implemented. Other back room deals with pharma also made sure that there was zero chance for negotiated prices for prescription drugs, zero chance for reimportation of prescription drugs and zero chance of eliminating the overcharge for prescription drugs for dual eligible Medicare/Medicaid patients.

    The back room deals were choices that Obama made. Choices that greatly increase the cost of care and ensure that the U.S. will continue to pay 2 - 3 times more for health care services and 35% - 50% more for prescription drugs.

    I think that it is you that is living in a fantasy world. This POS legislation will prop up one of the worst health care systems in any developed country. It will succeed in making the insurance and medical industries even more wealthy and powerful and better able to continue to purchase the government that it needs to maintain their overpriced services at the cost of the health and welfare of the American people.


    Well, if YOU believe there ... (5.00 / 1) (#53)
    by Yman on Thu Jan 20, 2011 at 07:55:56 AM EST
    ... was zero chance of passing a public option, then I guess it must be true.  Others are of the opinion that a public option (already a watered-down option compared to single-payer) was possible, and that was it was a complete lack of leadership from Obama that killed it.  Heck, even Obama must have thought it was possible, since he promised a public option when he was running for office.  Of course, back then, he was also mocking the idea of individual mandates, when he thought it would help win him the nomination.  I guess it's possible that he just didn't know enough about HCR and he was just "winging it" when he was campaigning - hard to believe given the importance of HCR as a major issue.  OTOH, the obvious answer is he was just lying to people to win their votes, and now his blind loyalists are upset when others want him to be accountable for his own words/promises.

    You choose.


    Hear, Hear (5.00 / 1) (#25)
    by MO Blue on Wed Jan 19, 2011 at 04:25:14 PM EST
    This liberal supports Medicare for all.

    No more detours on faux public options for me. Single payer is the only system which will generate support from me now or in the future.