Sleazy Sewers and Healthcare Reform
| Wed Dec. 16, 2009 6:02 PM PST
Glenn Greenwald has this to say about the Senate healthcare bill now that the public option and the Medicare buy-in have been stripped out:
In essence, this reinforces all of the worst dynamics of Washington. The insurance industry gets the biggest bonanza imaginable in the form of tens of millions of coerced new customers without any competition or other price controls. Progressive opinion-makers, as always, signaled that they can and should be ignored [...]
Most of this was negotiated and effectuated in complete secrecy, in the sleazy sewers populated by lobbyists, industry insiders, and their wholly-owned pawns in the Congress. And highly unpopular, industry-serving legislation is passed off as "centrist," the noblest Beltway value.
This is pretty much correct. The individual mandate was a way of getting support from the insurance industry. The backroom deal with Big Pharma was a way of getting support from the drug industry. The change in Medicare reimbursement rates was a way of getting support from doctors. The gutting of the Medicare commission was a way of getting support from hospitals. Provisions related to biologics, home healthcare, and the prescription drug doughnut hole were a way of getting the support of AARP.
Any honest observer has to concede that all this makes it hard to defend the final product. Except for one thing: in 1994 Bill Clinton failed to get the support of these groups and healthcare reform died. If Obama had done the same, it would have died this year too. There's really just no question about this. It's ugly, but that's the real world. Which brings me to the place where I think Glenn is wrong:
Looked at from the narrow lens of health care policy, there is a reasonable debate to be had among reform advocates over whether this bill is a net benefit or a net harm.
From any kind of progressive point of view it's hard to see how you could seriously argue that the current bill is a net harm. Sure, it makes compromises to powerful interests that are hard to swallow. But that's why they're called powerful interests: because they can kill your legislative priorities if you don't assuage them. In return, though, the Senate bill brings down insurance rates, expands Medicaid, offers the prospect of moderately priced insurance to tens of millions of the uninsured, forces insurers to take you on even if you have a chronic pre-existing condition, mandates minimum levels of coverage, and takes several small but important steps toward reducing the future growth of healthcare costs. That's an enormous advance for the progressive agenda.
There's an alternate universe out there in which you could get all this stuff without compromise based on the sheer force of progressive arguments. Sadly, it's not this universe. I sure hope we don't have to learn this the hard way yet again.
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Health care
Submitted by E L (not verified) on Wed Dec. 16, 2009 6:39 PM PST.
On July 25, 1593, Henry IV: "Paris is well worth a mass."
From reading the comments on
Submitted by g. powell on Wed Dec. 16, 2009 6:40 PM PST.
From reading the comments on your site, not only do we have to learn the lessons of 1994 all over again, we also have to sit out the next couple of elections to enable the GOP to win again.
Great fucking plan. No wonder the GOP hits above its weight: Their base is smarter than ours. Hell, their base is more reality-based than ours.
All Their Base..
Submitted by jimBOB on Wed Dec. 16, 2009 7:16 PM PST.
Their base isn't smarter than ours, as even a cursory glance at the tea partiers would show. But they are working in concert with very powerful, moneyed interests, while we are attempting to accomplish very difficult things. Absent the supposed 60-vote supermajority requirement (which is a recent invention of the Senate, not some constitutional mandate), we'd be done already.
Certainly the whole tea-party
Submitted by g. powell on Wed Dec. 16, 2009 7:42 PM PST.
Certainly the whole tea-party phenomena marks a whole new crazy era for the GOP, and I'm not sure that it helps the party. I sure hope it hurts them.
But the point that I've repeated over and over again is that the GOP base has been more politically pragmatic in general than the progressive base, and it has yielded results. They understood the incremental nature of our system, and worked with it. We progressives have been fighting defense for the last 30 years.
That said, it's a good thing that people apply pressure for good legislation. But don't sit out an election or not donate money.
There was an incremental approach to the wars in Afghanistan & Iraq, Homeland Security, NSA/telecom spying on Americans, tax cuts for the wealthy, two extremely conservative USSC judges appointed, etc., etc. If those things are incremental, let's hope they never really get pushy.
Incrementalism is great.
Submitted by mark robbins (not verified) on Thu Dec. 17, 2009 9:26 AM PST.
Incrementalism is great. But forcing a bunch of middle class taxpayers to buy insurance from insurance companies that they haven't already bought because it's too expensive and offers too few benefits is a dead losing strategy. Liberman knows it. He's out to make an unpopular bill that the electorate will punish the Dems for and then flip to the Republican party when they control the senate. The only reason he's not a republican is because he doesn't want to lose his committee power.
This might be a good bill on the balance. But it's like the Dems went out and said how can we fuck the working poor, college kids, and struggling mid-career folks the most. This is not shared sacrifice. No one is going to be hurt by this bill except...hard working folks who don't really have any extra money.
How many people are going to put off going to the doctor because they have to pay their health insurance bill? Can't afford 75 bucks to go see my GP and get that x-ray because I had to buy a 500 a month catastrophic insurance policy.
This is literally a nightmare scenario...how can these people be so obtuse?
30K is like making nothing in this country, but it puts you so far afield from medicade or government subsidies that you're just going to get left out in the breeze.
I'll put it plain: If the government forces me to buy shitty insurance from an insurance company that covers nothing and redirects money I'd have spent on GPs and dentistry I'm voting Republican in 2012. For the first time ever for any office in any election.
Because really, why did I elect this guy?
To do exactly what Bush did/would have done except I have to thank him for it?
jimBOB- read the comments
Submitted by g. powell on Wed Dec. 16, 2009 9:36 PM PST.
jimBOB- read some of the comments below and tell me how smart our base is.
Well, sir, a glance your way
Submitted by Anonymous (not verified) on Thu Dec. 17, 2009 4:50 PM PST.
Well, sir, a glance your way doesn't necessarily lead to a judgement as intelligent either! Don't judge the Partiers by looks, as I was there and there was quite a variety of middle America there; few on the coasts recognize us, but that is not my problem with this smug statement.
Send the GOP base to
Submitted by tpx on Thu Dec. 17, 2009 9:07 AM PST.
Send the GOP base to Afghanistan.
Who do you think have always fought your wars?
Submitted by Anonymous (not verified) on Thu Dec. 17, 2009 2:40 PM PST.
Send the GOP base to Afghanistan?! They are already in Afghanistan! Progressive don't join the military... they protest the military.
Comments like this are just ignorant... keep telling yourself you're smarter than the GOP base.
"Progressive don't join the
Submitted by Anonymous (not verified) on Fri Dec. 18, 2009 3:52 AM PST.
"Progressive don't join the military... they protest the military." I have to take serious exception to the above comment. As a progressive who has proudly worn our country's uniform for more than a decade I can tell you that is just flat wrong. There are many of us who believe that it is possible to support the political, social and economic priorities of the moderate left while being willing to lay down our lives to defend one of the world's most open and fragile systems of government. Please make the distinction between the military policies pursued by our government (which many of us who know how to wage war privately think are often foolish) and the men and women who ensure that the Republic in which this robust debate is occurring stands for another 200 years.
The right's agenda is just wrong headed. Plain and simple. But they win election after election because too many progressives just don't get the fact that the overwhelming majority of Americans are religious and patriotic. If you cannot engage them on that level, all other bets are off. Its comment like the one quoted that give the right all the ammunition they need to win at the polls and kill our legislative priorities.
Finally, a "progressive"
Submitted by Anonymous ncarrizo (not verified) on Thu Dec. 17, 2009 1:34 PM PST.
Finally, a "progressive" (probably "regressive" would be a more appropriate label seeing as how the entire camp evidently like the "one step forward, two back" approach to "progressive" goverrnment!) who gets it!
I think one of the issues
Submitted by Anonymous (not verified) on Wed Dec. 16, 2009 6:49 PM PST.
I think one of the issues being neglected in this debate among progressives is:
Does this reform, over time, gradually weakens the political power of those interests, or does it merely further entrench them. I could see passing a weaker bill in order to set up a framework for future reform (like truly universal, catastrophic coverage), or passing a bill that slowly redirects a growing percentage of industry profits.
ie. sacrificing a little bit now to gain something even better in the future. I just don't see how this whole process did anything more than entrench the interests further, make Joe Lieberman and rightwing Democrats even more powerful, and break up the reform coalition.
"the Senate bill brings down
Submitted by Mike F (not verified) on Wed Dec. 16, 2009 6:59 PM PST.
"the Senate bill brings down insurance rates".
I've seen no evidence that convinces me that this is true.
The bill before the Senate now is basically a very weak emulation of what the Swiss, who have the second highest per capita health care costs in the world, now have.
And this is what the Swiss have to show for it, even given much stronger protections against insurance company profiteering:
"On average, out-of-pocket payments [for the Swiss] come to $1,350 annually. That is the highest among the 30 countries tracked by the O.E.C.D. and well above the $890 average for the United States, which comes in second."
http://www.nytimes.com/2009/10/01/health/policy/01swiss.html?pagewanted=all
Pass it.
Submitted by Pokeybob (not verified) on Wed Dec. 16, 2009 7:05 PM PST.
A foot in the door. And all of the Rethugs will vote no too. That's how much they hate even this bill.
Does it really? ..
Submitted by Calvin Jones an... on Wed Dec. 16, 2009 7:08 PM PST.
What are the controls long term? Have you read anything Emptytwheel wrote in the past 36 hours on it?
Answers
Submitted by Dems Lose Huge in 2010 (not verified) on Wed Dec. 16, 2009 7:11 PM PST.
http://www.dailykos.com/storyonly/2009/12/16/815402/-20-answers
Giving Congress back to the Republicans is not worth it. Or is it?
Have the Dems ever done ONE thing to help people over corporations?
They could pass and sign this bill, then push the public option and medicare buy in through reconciliation. But they won't -- they care more for corporations than people. And that is the irreducible fact.
And they will pay in 2010.
http://tpmcafe.talkingpointsmemo.com/2009/11/30/progressives_and_obama_a...
If you think we've accomplished nothing, you simply can't see the forest for the trees. Let us have no doubts that the Republicans can and have done far worse.
As I understand it, the bill
Submitted by Anonymous (not verified) on Wed Dec. 16, 2009 7:31 PM PST.
As I understand it, the bill has huge loopholes that insurance companies can easily get around. I trust Howard Dean and Wendell Potter on this; they both think the provisions you cite (preexisting conditions, caps, etc.) are empty promises, because you can't trust the health insurance industry. What good is a preexisting conditions clause if companies offer insurance that's unaffordable? How can mandates remain when cost controls and choice have been removed? Why is healthcare a for-profit enterprise at all?
I really am on the fence about this bill. And the Senate is disgusting, with about 5 exceptions. Just repellent.
Naive
Submitted by Cranky Observer (not verified) on Wed Dec. 16, 2009 7:43 PM PST.
It is really quite naive to post this argument without confronting the Charlie Brown-Lucy-football counterargument. The plain fact is that progressives and liberals are expected to given their money, their votes, and their dignity to the most conservative of the Democrats and never, ever, ever get anything in return. At some point that will stop; whether it is via a wake-up call such as killing this health care bill or a debacle such as a complete Republican recapture of the 3 branches when the base stays home is up to the "leaders" of the Democratic Party.
Cranky
I feel like my father did in
Submitted by mark robbins (not verified) on Thu Dec. 17, 2009 9:30 AM PST.
I feel like my father did in '96. Broken promises and wasted opportunity. He voted Nader in 2000 and 2004.
The Dem's will be lucky if I vote for a third party in 2012.
Choices?
Submitted by Jingjok (not verified) on Wed Dec. 23, 2009 2:05 AM PST.
What will keep people from buying cheap, crappy policies when they are not sick, and expensive good policies when they get sick?
Simple -- the insurance companies. They aren't going to offer cheap crappy policies or expensive good policies. The only policies they will offer will be expensive crappy policies. And the premiums aren't going to be affordable, either. Once they've figured out how much the subsidies amount to they will push up the premiums to absorb all the subsidies and then some. With no cost controls why would they offer cheap policies?
Oh, yeah, and in the Senate bill as it is now they are not prohibited from rescinding your policy if you get sick after paying for years. The provision is that they can only rescind your policy in case of fraud or error! What reasons do you think they give now?
"The individual mandate was a
Submitted by Tlaloc (not verified) on Wed Dec. 16, 2009 7:51 PM PST.
"The individual mandate was a way of getting support from the insurance industry."
That's a clue. Any "reform" that has the support of the insurance industry is not reform at all.
" Any honest observer has to concede that all this makes it hard to defend the final product. Except for one thing: in 1994 Bill Clinton failed to get the support of these groups and healthcare reform died. If Obama had done the same, it would have died this year too. "
So our choice is between no bill and a bill that absolutely should not pass? A bioll that only makes the situation worse? Great. I think I (and apparently a number of others) see option (a) as the right choice in that case.
The status quo is horrible, but that doesn't mean it can't be worse, this bill makes it worse.
"From any kind of progressive point of view it's hard to see how you could seriously argue that the current bill is a net harm."
Funny I can't imagine how you claim it is a net plus! Look this bill unarguably will lead to more costs. It does nothing to control the prices the insurance companies charge while forcing us to buy no matter what. Can you think of any situation more likely to lead to the price skyrocketting? We're turning the US into their personal ATM to use however and whenever they see fit.
The subsidies will be instantly eaten up by the huge raise in insurance costs.
At the same time we include some toothless regulations that do nothing to actually stop the insurance companies from getting rid of whomever they wish and cancelling any coverage they want. The regulations useless except in making it harder to do further regulation because when they fail (i.e. the day after implementation) the right will point and be able to say "look they tried regulation, it cost you a ton and did nothing to improve service, obviously regulation is the wrong idea."
So what do we get out of this bill that even begins to counteract the enormous harm done? Please tell me, I'd love to shake this nauseated feeling I have, but so far I've heard no defenses of the bill that recognize reality.
You keep saying this bill will bring down costs but I see nothing to support that claim at all. On the contrary it seems to be tailor made to drive the costs into the stratosphere.
Kevin is not a progressive,
Submitted by MNPundit (not verified) on Wed Dec. 16, 2009 10:48 PM PST.
Kevin is not a progressive, so that's why he can make mistakes about a progressive viewpoint. He's just unfamiliar with it.
super-majority requirement and the un-representative senate
Submitted by cld (not verified) on Wed Dec. 16, 2009 8:01 PM PST.
It all comes back to the super-majority requirement and the un-representative nature of the Senate.
Super-majorities are a problem everywhere and banning them and reforming the representation in the Senate can only be done through Constitutional Amendment.
It might take twenty years, but until it happens what we have seen this year will continue. It will continue forever.
Then what's the problem with
Submitted by cld (not verified) on Wed Dec. 16, 2009 8:34 PM PST.
Then what's the problem with California?
Has a super-majority requirement ever been repealed?
Pass It
Submitted by Detroit Dan on Wed Dec. 16, 2009 8:20 PM PST.
I'm not anti-big business, and all this bashing of the insurance companies is stupid. It's not the insurance companies, it's the system, which is crappier than hell.
I do believe that single payer would be a much better approach. And I really doubt that nothing happens for 20 years if we don't pass this. The current system is so bad that there will be pressure from all sides for change, regardless of whether or not this passes.
The Dems apparently were not successful in getting the support of the insurance industry and the Chamber of Commerce, in spite of all the concessions. Not to mention all Republicans, and the progressive base.
Whatever happens, the Dems should come back with a true government-run proposal which would end employer-based insurance and be effective at controlling costs. With Americans paying an average of almost $1,000 per year out of pocket. the prospect of a government run system will be a money saver for the middle class, as well as a windfall for business. It's good policy and good politics.
Sure, the health care insurance industry will be understandably upset at the prospective loss of their industry. But the Dems need to get on the right side of this issue. A lot has changed since 1994...
I don't think the politics of
Submitted by Sojourner on Wed Dec. 16, 2009 8:32 PM PST.
I don't think the politics of healthcare reform are going to get much better. We have to accept the fact that America as a country is deeply suspicious of giving government authority and responsibility, even in cases where it's had that responsibility for decades and done a pretty good job.
So your argument is that
Submitted by rbe1 (not verified) on Thu Dec. 17, 2009 1:42 PM PST.
So your argument is that Americans are too ignorant to realize that the current government health care systems (Veterans care and Medicare, plus the government run health care available to our esteemed senators and congressmen) are actually superior to those financed exclusively by private insurance ? If so I would agree, but would have to add intellectually lazy and not a little stupid.
No
Submitted by swr112261 (not verified) on Fri Dec. 18, 2009 5:35 AM PST.
The American people realize that the country is awash in red ink and that this monstrosity of a bill will only make things worse. The post office loses $7 billion annually. It doesn't take a genius to conclude that taking over 1/6th of the US economy in the middle of a recession, particularl when the system is working for 90 percent of us, isn't smart.
Well...
Submitted by Jingjok (not verified) on Wed Dec. 23, 2009 2:12 AM PST.
Actually, the reason the post office loses money is because of the requirement that they deliver junk mail/advertising below cost. If the Congress would allow them to raise the price for bulk mail they could turn a profit, even though they are still required to deliver to sparsely populated parts of the country. Congress doesn't allow it because the "direct mail industry" has lobbyists taking care of their interests.
"..the prospect of a
Submitted by methinks (not verified) on Thu Dec. 17, 2009 9:05 PM PST.
"..the prospect of a government run system will be a money saver for the middle class....It's good policy and good politics."
--Yeah right - like Medicare, Medicaid, and Veteran's benefits? Every one of those government-run programs is more expensive than promised, going broke from fraud and waste, won't cover doctors' basic expenses, and Medicare denies claims from a higher percentage of patients than any of the insurance companies. Don't you people read anything except your own opinions?
Everyone says the existing
Submitted by Anonymous (not verified) on Thu Dec. 17, 2009 11:16 PM PST.
Everyone says the existing system is terrible but last I read 84% in the US like their present insurance, and the majority of the uninsured are because they choose not to buy though they can afford it. Add to that the current system's ability to support the incredibly capital intense biopharm R&D that has produced the medicines that have changed the world's health prospects, and I cannot understand why there is such a trumpet call for a wholesale change.
I think there should be one change made that would improve things tremendously - that pre-existing conditions cannot be rated or declined. This would elevate everyone's premiums a little but the spread would make chronically ill folks insurable, a worthy trade-off.
But throwing everything out for a single payer system? Isn't it true 7 of 10 men diagnosed with prostate cancer in England die, where 3 in 10 do in the US? And 6 of 10 women diagnosed with breast cancer in England die, whereas 2 in 10 in the US do? And... everyone in England is insured. They have coverage, but it is absolutely terrible coverage.
And so will we if we follow suit.
You need to check your statistics
Submitted by Jingjok (not verified) on Wed Dec. 23, 2009 2:42 AM PST.
According to http://info.cancerresearchuk.org/cancerstats/types/prostate/ the survival rate in England is 7 out of 10. I've seen your claim on tea partiers' signs but don't know where they got it from.
http://www.statistics.gov.uk/CCI/nugget.asp?ID=861 shows a chart that indicates a survival rate of a little over 80% for women with breast cancer. Their chart also shows survival rate for prostate cancer a bit over 70%.
dumb, stoned or elected by suckers?
Submitted by cld (not verified) on Wed Dec. 16, 2009 8:32 PM PST.
Watch Mary Landrieu, right at the end, insist that the present bill contains a 'non-profit public option',
http://tpmlivewire.talkingpointsmemo.com/2009/12/landrieu-on-health-care...
New Orleans is an insurance
Submitted by g. powell on Wed Dec. 16, 2009 8:47 PM PST.
New Orleans is an insurance industry hub.
"If Obama had done the same,
Submitted by Anonymous (not verified) on Wed Dec. 16, 2009 8:47 PM PST.
"If Obama had done the same, it would have died this year too. There's really just no question about this."
Bullshit. Obama barely did anything about this bill. He didn't go to the public, he didn't use his bully pulpit, he didn't do any jawboning, he barely negotiated anything besides surrender.
If LBJ could get civil rights, Obama could have gotten health care.
Especially when you consider this time around that much of industry (GM Overhang) wants it.
What actually happened is instead of tough negotiations and politics, we tried bribery, disarmament, and surrender.
In the 88th Senate, LBJ had
Submitted by g. powell on Wed Dec. 16, 2009 8:53 PM PST.
In the 88th Senate, LBJ had 67 Dems and liberal Republicans on top of that.
Do the math, if you're capable. It's not the same.
He also had balls and was not
Submitted by Anonymous (not verified) on Wed Dec. 16, 2009 10:38 PM PST.
He also had balls and was not afraid to tell people on which side his dick hung.
Nothing like a significant
Submitted by g. powell on Thu Dec. 17, 2009 5:07 AM PST.
Nothing like a significant majority in the Senate to make you feel like a big man.
"LBJ had 67 Dems" and 21 of
Submitted by alex (not verified) on Thu Dec. 17, 2009 7:32 AM PST.
"LBJ had 67 Dems" and 21 of them voted against the Civil Rights Act of 1964, after they filibustered it. The bill had more Republican than Democratic support, but LBJ had the balls to twist arms and oppose entrenched interests in his own party.
But it was a different GOP
Submitted by g. powell on Thu Dec. 17, 2009 9:11 AM PST.
But it was a different GOP back then. The times now are much different, healthcare reform probably won't get a single GOP vote regardless of content. That isn't Obama's fault. He has absolutely no margin of error in the Senate.
You know, you're absolutely
Submitted by rbe1 (not verified) on Thu Dec. 17, 2009 2:14 PM PST.
You know, you're absolutely right. The problem is that we on the progressive, liberal side have failed to come up with a single god-damned political strategy to offset the movement toward a monotheistic republican party. And you know what ? That's what we hire politicians to do. I lay this failure right at the feet of the democratic party leadership, which has nearly cowed itself out of existence. Give me 60 Bernie Sanders, and maybe something could change. For now, we're stuck with a bunch of hand-wringing wimps who look at us with those big doe eyes and exclaim "What can we do ? We just don't have the votes !" Pathetic.
Wake up Mr. President, and smell the electoral swamp coming to drown your supposedly progressive party in 2010 and 2012.
To really oppose Lieberman, a
Submitted by tpx on Thu Dec. 17, 2009 4:28 PM PST.
To really oppose Lieberman, a senator must filibuster the bill that provides military aid to Israel. If the traitorous senator from Connecticut thought for one minute his opposition to the public option would cost his dearly beloved Israel one bullet, he would not only vote for the public option, he would become its most ardent supporter.
I am a Jew, understand
Submitted by bham (not verified) on Sat Dec. 19, 2009 4:11 AM PST.
I am a Jew, understand healthcare better than you, and also hate Lieberman, but if you really think the key to victory is to shut off funding for Israel, then you aren't very smart. He is a narcissist , plain and simple. Hate him as I do for his self importance, but it has nothing to do with being Jewish. Jews vote 90% democratic. Think about that. Seriously, think about that.
re: Jewish Dem vote
Submitted by b-psycho (not verified) on Sat Dec. 19, 2009 8:38 AM PST.
Do they vote 90% Democratic because of aid to Israel (which really doesn't need it)? Or because they think Democrats are best for the U.S.?
I agree, it's not because Lieberman is Jewish. It's because on the only matter where he has discernible principles he lines up with neo-imperialists. He's still mad that the party base dropped him over his pet issue, so he's going to monkey wrench theirs, it's that simple.
So it is the GOP's fault that
Submitted by Anonymous (not verified) on Thu Dec. 17, 2009 2:44 PM PST.
So it is the GOP's fault that the Democrats can't craft a plan that their own members can support?
To win this majority, Congressional Democrats pushed for conservative Democrats to run against unpopular Republicans and now you're mad because they are acting like conservative Democrats and representing their constituents.
What color is the sky in your world?
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