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20 Answers on why the health care bill needs to die for Nate Silver

2009 December 17
by Ian Welsh

Nate Silver has some questions for those who want the health care bill to die. Since many of these questions are common ones, here are answers.

1. Over the medium term, how many other opportunities will exist to provide in excess of $100 billion per year in public subsidies to poor and sick people?

a. Over the medium term, how many other opportunities will exist to force people to spend money they don’t have on insurance that doesn’t have a cap on expenses and in some cases only has a 70% actuarial value?  100 billion in subsidies doesn’t mean squat if they come tied to an expense people can’t afford, making them buy insurance which is not particularly useful.

2. Would a bill that contained $50 billion in additional subsidies for people making less than 250% of poverty be acceptable?

No.  Even at 300% or 401% (sbusidies cutting off at 400%), there are people who will be forced into bankruptcy by this bill.  Repeat after me, no cap on expenses, and inadequate cost controls.

3. Where is the evidence that the plan, as constructed, would substantially increase insurance industry profit margins, particularly when it is funded in part via a tax on insurers?

Stock values of pharma, insurance companies and healthcare companies in general are up, that’s because the market thinks the plan will increase their profits.  Where is the evidence that forcing 30 million people to buy a product with actuarial values as low as 70% wouldn’t increase profits?

4. Why are some of the same people who are criticizing the bill’s lack of cost control also criticizing the inclusion of the excise tax, which is one of the few cost control mechanisms to have survived the process?

Because the excise tax is not inflation adjusted, which means that over time it will force companies to reduce the quality of their plans.

5. Why are some of the same people who are criticizing the bill’s lack of cost control also criticizing the inclusion of the individual mandate, which is key to controlling premiums in the individual market?

Because the mandate, as noted above, will force people who can’t afford insurance to buy bad insurance.  Also, if you take a look at Massachussets, where they have a mandate, you will find little evidence that a mandate has controlled costs.  A mandate by itself is not sufficient to control costs, all it does is set up a company shop.  Absent hard regulation of the sort of the US has proven very bad at enforcing (see Crisis, Financial) a mandate is just a looting license.

6. Would concerns about the political downside to the individual mandate in fact substantially be altered if a public plan were included among the choices? Might not the Republican talking point become: “forcing you to buy government-run insurance?”

Not if it were a robust public option which reduced costs.  Good policy makes people happy.  And no one would be forced to buy the public option anyway, it’s an option. Only one of many choices.

7. Roughly how many people would in fact meet ALL of the following criteria: (i) in the individual insurance market, and not eligible for Medicaid or Medicare; (ii) consider the insurance to be a bad deal, even after substantial government subsidies; (iii) are not knowingly gaming the system by waiting to buy insurance until they become sick; (iv) are not exempt from the individual mandate penalty because of low income status or other exemptions carved out by the bill?

How many people are going bankrupt a year now?  Well, in the first 9 months of the year, 1,046,449.  Average that out for the year, and assume we hit something over 1.3 million.  Now, how many MORE people would go bankrupt if they were forced to spend money they don’t have on insurance they can’t afford, which has no caps on expenditures and when things were getting tight couldn’t dump that insurance?

8. How many years is it likely to be before Democrats again have (i) at least as many non-Blue Dog seats in the Congress as they do now, and (ii) a President in the White House who would not veto an ambitious health care bill?

They already have a president in the Whitehouse who doesn’t want an ambitious health care bill and has worked hard to make sure there isn’t one.  Here’s my question for you.  Given cost realities, which no, this bill doesn’t address, how many years will it be before it will be even more clear that something has to be done?  But in any case, pushing through a bill which is worse than the status quo is not a victory, so this question is a non-sequitur.

9. If the idea is to wait for a complete meltdown of the health care system, how likely is it that our country will respond to such a crisis in a rational fashion? How have we tended to respond to such crises in the past?

Well, in the Great Depression the US responded quite well.  Of course, there’s a 50/50 chance that instead of getting an FDR you may get something much worse, but again, passing a bad bill now isn’t superior to passing no bill at all, so this is a non-question.

10. Where is the evidence that the public option is particularly important to base voters and/or swing voters (rather than activists), as compared with other aspects of health care reform?

Well, the public option has regularly polled as popular, and in the meantime 40% of democratic voters are currently stating that they are so demoralized they are thinking of staying home in 2010. We can’t know how much of that is related to this lousy healthcare plan, but given that healthcare has dominated the news from DC for, oh, 6 months, I think it would be surprising if it wasn’t a huge factor.

11. Would base voters be less likely to turn out in 2010 if no health care plan is passed at all, rather than a reasonable plan without a public option?

I don’t know, and neither do you.  What I do know is that doing something bad is worse than doing nothing at all.

12. What is the approximate likelihood that a plan passed through reconciliation would be better, on balance, from a policy perspective, than a bill passed through regular order but without a public option?

Very high, since it is 3 or 4 Senators who keep blackmailing out the better parts of the bills, and reconciliation needs only 51 votes.

13. What is the likely extent of political fallout that might result from an attempt to use the reconciliation process?

Well, Bush used it to pass tax cuts for the rich, and no one seemed to care much.  Granted Democrats aren’t allowed to do what Republicans do.  Probably you’d have a hard time passing anything till the next election that didn’t require reconciliation, or which you didn’t stick in a miltiary funding bill.  But so what?  Getting through one really good bill, and with reconciliation you could put through a bill with a real public option, not the watered down House version, would be worth it.  Except, of course, that the President doesn’t want a good bill.  But, again, this is a bad bill.

14. How certain is it that a plan passed through reconciliation would in fact receive 51 votes (when some Democrats would might have objections to the use of the process)?

Not completely certain.  But again, if it fails, I don’t care.  This bill is bad, if it dies, it dies.  Better no bill, than a bad bill.

15. Are there any compromises or concessions not having to do with the provision of publicly-run health programs that could still be achieved through progressive pressure?

Can’t think of anything significant offhand.

16. What are the chances that improvements can be made around the margins of the plan — possibly including a public option — between 2011 and the bill’s implementation in 2014?

Since indications are that Democrats will lose seats in 2010, not much.

17. What are the potential upsides and downsides to using the 2010 midterms as a referendum on the public option, with the goal of achieving a ‘mandate’ for a public option that could be inserted via reconciliation?

Can’t be done.  The Democratic party is not willing to run  on it, and progressives cannot run on it alone.  Again, there is no indication the President wanted a public option, certainly none that he pushed for it any meaningful way.

18. Was the public option ever an attainable near-term political goal?

Yes.  The President wants a bill very badly.  If Progressive legislators were willing to walk, they would have bargaining leverage.

19. How many of the arguments that you might be making against the bill would you still be making if a public option were included (but in fact have little to do with the public option)?

Frankly the House public option was already so weak that the bill was already dead to me.  Reconciliation is only useful if it offers a chance to get a better public option than the House public option.

20. How many of the arguments that you might be making against the bill are being made out of anger, frustration, or a desire to ring Joe Lieberman by his scruffy, no-good, backstabbing neck?

I have been against this bill for a couple months now.  Any frustration I have is only because the bill is so bad it needs to die.

41 Responses
  1. December 17, 2009

    3. Where is the evidence that the plan, as constructed, would substantially increase insurance industry profit margins, particularly when it is funded in part via a tax on insurers?

    you don’t need to increase profit margins to increase profits if you increase revenues. and iirc the tax on insurance doesn’t get counted in the mlr calculation [but i could be misrembering, and i’m too lazy to go look it up].

    13. What is the likely extent of political fallout that might result from an attempt to use the reconciliation process?

    voters don’t care how legislation gets passed, just whether it works for them or not. i suppose it’s possible that big money donors might care.

    20. How many of the arguments that you might be making against the bill are being made out of anger, frustration, or a desire to ring Joe Lieberman by his scruffy, no-good, backstabbing neck?

    count me among those who think that probably lieberman has the blessings of the white house.

  2. December 17, 2009

    If Progressive legislators were willing to walk, they would have bargaining leverage.

    Who are these people? If they are not willing to walk, and this is an anti-progressive bill, why do you call them “Progressive legislators”?

    It’s really very circular.

    If the progressive thing to do is to kill this bill, then by definition any legislator not willing to kill it is…?

  3. December 17, 2009

    Anyway, maybe Bernie Sanders will be willing to kill it or something. I will eat about half a plate of crow at that point. I will eat the other half if a significantly better bill happens in this Congress after that.

  4. Ian Welsh permalink
    December 17, 2009

    You are becoming tiresome. I have never predicted anywhere that progressives would kill the bill, only that they could. I have predicted nowhere that they will seriously bargain by threatening to kill the bill, only that they could. If they choose not to, that is a choice they make, not that I make. Please do attribute to me positions I have not taken.

    This is a post about whether the bill should be killed, not whether it will be. I do not think it will be, but that is not the question.

    However, I do know that if everyone says “fuck it, it’ll never be killed and progressives will never negotiate, so let’s none of use let them know that if they do they have support” that it will become a self-fulfilling prophecy.

  5. December 17, 2009

    Bravo.

    To which I will add, I think the mandates are likely to stall any employment recovery. It seems likely that the insurance companies will work very hard to raise rates to sop up all spare cash from independents and this is money that will not be spent on the production of anything other than financial paper.

  6. Ian Welsh permalink
    December 17, 2009

    Raven,

    yes. When you have a monopoly, rational economic behaviour is to take everything short of killing the goose. (And if a geese die that’s ok, just don’t kill the flock as a whole.)

  7. Lex permalink
    December 17, 2009

    Sanders says he won’t vote for it, and Reid might not have the votes for cloture if Sanders won’t vote for that.

    The WH seems fine with the meat of this bill, and in any case simply wants a bill so that Obama can have a ceremony and call himself the second coming of FDR. They know it’s crap; that’s why they have it kicking in after Obama runs for a second term. Same-old-same-old political BS: kick the can down the road in such a way that you can take credit for something today.

  8. Ian Welsh permalink
    December 17, 2009

    Depends if Sanders will vote against cloture or not. Voting against the bill means nothing, voting against cloture means everything.

  9. Alacrity Fitzhugh permalink
    December 17, 2009

    All this healthcare debate is incredible when considering that the United States is currently in a financial tail spin. Costs must be kept down and the public option seemed to be the way to do it. Continuing to print money just devalues the dollar.

    Reconcilation is the way to go, because it’s the only way possible to push through a workable bill at this point.

    All Americans deserve good, affordable healthcare.

    Now for full disclosure:

    I am a Canadian and currently enjoy the healthcare that you are trying to get.

    America having healthcare helps you and helps your nothern neighbour. Your low dollar value is not helping exports up here and we seem to be in the business of selling to the United States.

    Big Pharma can suck my left nut.

  10. Ian Welsh permalink
    December 17, 2009

    But would Hobart Floyt agree?

  11. December 17, 2009

    You are becoming tiresome. I have never predicted anywhere that progressives would kill the bill, only that they could. I have predicted nowhere that they will seriously bargain by threatening to kill the bill, only that they could. If they choose not to, that is a choice they make, not that I make. Please do attribute to me positions I have not taken.

    I’m sorry, but you’ve repeatedly implied (take your answer to 18, your responses to me in “Enough”, and so on) that there exists a set of extant progressive Democratic legislators of sufficient significance that they would have an effect on the outcome, where they merely to choose to filibuster.

    If I’m misinterpreted you and/or misread your claims, I apologize. It seems plain as day to me, though.

    If I haven’t, then I am suggesting that the apparent improbability of any senators blocking cloture challenges your assumption/implication. If the bill is so obviously bad and it is so important to the progressive cause to block it, then any senator not filibustering is not a progressive by definition.

    Isn’t that the case?

    And if it is not the case that there are any progressives in the Senate (I’ll grant you a small number in the House, insofar as they have no power to make a difference), what does this imply about electoral politics in the USA?

  12. December 17, 2009

    er, “…were they merely…” in para 1. *smacks forehead*

  13. Ian Welsh permalink
    December 17, 2009

    Believing something and having the balls to do something about it aren’t the same thing.

    Nowhere have I predicted that a progressive WILL stop the bill, I have only said they CAN stop the bill. You are missing the distinction between predictive and prescriptive. Progressives should. That doesn’t mean I think they will. If there’s a 10% chance something will happen, it could happen, but I don’t put money on it. That doesn’t mean I might not push for it to happen, if it’s a good thing.

    Dean’s out there trying to get the bill killed. I’m going to back him up as best I can, because there’s a chance it might happen. That doesn’t mean I think it’s /probable/ it will happen, just that there’s a chance. (Bernie Sanders has said he’ll vote against, though whether he’ll vote against cloture is unknown.)

    And this post is about why the bill should be killed, not about whether progressives are progressives.

    You’re riding a hobby horse off into the horizon and you’re trying to say something that is only tangentially related to what I’m trying to say and pursuing it thread after thread like a dog with a bone. I think, Mandos, that you need your own blog where you could make your own arguments, clearly, rather than trying to shoehorn them in and turning every comment thread into Mandos’s pet peeve thread. “We’re all doomed. America is a right wing nut country with no progressives in power anywhere, so we shouldn’t even try. Waaaaaaah!”

    Your point that if people who call themselves progressive won’t throw down for progressive policy, then they aren’t progressive isn’t a bad one, but it also isn’t a given.

    So why don’t you make your argument clearly at your own place.

  14. December 17, 2009

    Your point that if people who call themselves progressive won’t throw down for progressive policy, then they aren’t progressive isn’t a bad one, but it also isn’t a given.

    So why don’t you make your argument clearly at your own place.

    If you really don’t think that the question of who or what is a progressive isn’t directly related to everything you’ve said on this subject—in fact, refutes it—then we’ll just have to agree to disagree.

    And if I can’t convince you, what chance do I have with anyone else I expect to convince, on a blog that no one is going to read (my old one or a new one I’ve occasionally considered starting, and not done so)?

    The point is not that progressives can’t do anything. It’s that passing a bad bill—a terrible bill, even—is a strategy that actually has few relative downsides. And because I consider you a friend, and you’re getting irritated, that’s the last I’m going to say on the subject here.

  15. December 17, 2009

    “I am become Mandos, destroyer of threads” (speaking of nuclear options).

  16. December 17, 2009

    My simple, one sentence, answer to Nate: “Why do you want Democrats to commit political suicide by swallowing this poison pill?”

    An individual mandate that shoves people into the jaws of the private insurance with no consumer protections to speak of because of all the exceptions, concessions and loopholes that the industry had written in by its paid flaks will come back to bite the Democrats in the ass until it is finally repealed by the next GOP administration that comes to power.

    Dumb, dumb, and dumber.

    KO got it just right in his special comment, and Howard Dean delivered the message to the president that progressives will not support him vigorously. If the president wants to emasculate himself politically, he can continue to try to push this monstrosity through. If he want to keep his grassroots base, he will get of his duff and get to work on a bill that is actually health care reform, not a gift to insurance and pharma on the back of the people.

  17. December 17, 2009

    I’m all for killing the bill, which has perverted a “public option” into a “private mandate.”

    That having been said, the next step is for progressives to refuse to vote for the bill, which if they do that, good for them for taking a principled stand.

    What will happen next, however, is that the bill will get even worse. In order to make up for the loss on the Left side, Reid will work to pick up votes on the Right. So now the anti-abortion amendments go back in, and in addition to being forced to buy bad health insurance, women are also prevented from ANY reproductive health payments including pap smears and breast exams and having their feet sized for shoes since they’re supposed to stay in the kitchen without any.

    Which, again, just accelerates the disastrous collapse of the whole health care system. But along the way increases overall misery. Which is better, frankly, than enabling it by voting for a crappy bill.

    Or to simplify the metaphor, if the fully-bribed Congress has been convinced to drive the bus off a cliff, then let’s drive faster. The sooner we wreck, the sooner the survivors can begin to pick up the pieces.

  18. December 17, 2009

    “Dean’s out there trying to get the bill killed.”

    Not true. This is a misperception of what Dean has explicitly said. Dean only to kill the Senate version. He wants House to write a bill for reconciliation, which only requires 51 votes in the Senate.

    Gov. Dean only wants the Senate bill killed. I only want the Senate bill killed. Progressives only want the Senate bill killed. Everyone wants something now, and we should get what we can through reconciliation instead of accepting a poison pill from the industry flaks in the Senate that are bought and paid for.

    Yes, only so much is possible through reconciliation. So, that’s what we can get now. Everyone knows that health care reform is going to be a work in progress until we finally get single-payer AKA Medicare for all.

    In the end, there won’t be a private insurance industry and the US health care system will look like Canada’s. Until that happens, Wall Street will be driving the game, always requiring the industry to produce profits that increase quarterly. CEO’s are hired to increase their stock prices, so they will gladly oblige the Street. The present system based on private insurance is unsustainable.

  19. December 17, 2009

    “Or to simplify the metaphor, if the fully-bribed Congress has been convinced to drive the bus off a cliff, then let’s drive faster. The sooner we wreck, the sooner the survivors can begin to pick up the pieces.”

    This is defeatist thinking. The human suffering involved in this approach is irresponsible.

    If something can be done, it should be. If it can’t, well, they we did out best and the blood is on someone else’s hands.

    The fact is that the Dems are not in there actually fighting. They are feigning fighting and not very well. This is a thinly veiled gift to the big donors. The only thing that speaks louder than money to politicians is angry voters.

    In the end, we may have to take to the streets to get their attention. They do pay attention to street theater because it gets wide media attention and scares the bejeezus out of them. They are a bunch of greedy chickenshits.

  20. December 17, 2009

    I admit to being defeatist. I’ve been saying all along (on FDL and C&L and elsewhere) that there’s absolutely no point in doing anything before we institute Campaign Finance Reform, because nothing will survive Congress that places the public interest before corporate welfare.

    I’ve been repeatedly scolded for that position, and “I told you so” only makes those people angrier.

    Human misery is inevitable in the present circumstance, and pretending otherwise is just denial. Until we make bribing Congress illegal again we don’t have democracy in America.

  21. December 17, 2009

    “All this healthcare debate is incredible when considering that the United States is currently in a financial tail spin. Costs must be kept down and the public option seemed to be the way to do it. Continuing to print money just devalues the dollar.”

    Nonsense. This is like saying that a basketball game is limited because there aren’t enough points.

    This betrays a total lack of understanding of a modern (post August 15, 1971) monetary system and plays into conservative hands. The US as sovereign provider of a non-convertible floating fx currency of issue is not financially constrained. If there are goods and services for purchase it can issue currency (i.e., credit the Treasury account) to purchase them. The government is not revenue constrained. As currency issuer, it does not have to tax or borrow to spend. The only constraints are (1) inflation and (2) fx.

    (1) Inflation is a monetary phenomenon. It only occurs when nominal aggregate demand exceeds real output capacity. The government can always reduce nominal demand if necessary as the economy approaches real capacity by reducing discretionary spending (pork) or raising taxes. It does not have to reduce non-discretionary spending.

    (2). The US dollar is the world’s reserve currency. It is always in demand. It fluctuates against other currencies largely based on conditions exogenous to the US. Anyone who thinks that the dollar is in danger of going to zero can send them to me and I’ll get rid of them for you. I’ll even pay the postage.

  22. December 17, 2009

    “I admit to being defeatist. I’ve been saying all along (on FDL and C&L and elsewhere) that there’s absolutely no point in doing anything before we institute Campaign Finance Reform, because nothing will survive Congress that places the public interest before corporate welfare.”

    I agree that this is the sine qua non. But that doesn’t mean that progressives have to work only for that. This is a huge challenge and it is going to take moving mountains to do it, because the people that have to do it are the people taking the money.

    This is probably going to take a huge crisis. Don’t worry. One is coming. Debt deflation is just beginning. The financial crisis was just the prelude.

  23. December 17, 2009

    Bill Mitchell is out with a blog post today that trashes the conservative meme about impending catastrophe because of rising government debt and “profligacy.” It conservative propaganda for tax cuts and socialism for the rich and bupkis for everyone one else, disguised in impressive sounding but meaningless economic BS.

    http://bilbo.economicoutlook.net/blog/?p=6708&cpage=1#comment-2405

    Don’t fall for this nonsense. This is seriously affecting the health care debate because even progressives have bought into memes like “bending the curve” and “cost cutting.” Moreover, it is undermining the progressive agenda across the board, since progressive s erroneously believe that social programs must “pay their way,” as if if were necessary to raise taxes or cut other spending to do so. This is just conservative propaganda load toward the rich.

    The way to control costs is demonstrably single-payer, as Medicare has shown. Everything else is BS, primarily because Wall Street requires ever increasing profits from the private insurer and pharma to keep their stock prices rising. There are plenty of loopholes and concessions in the Senate bill, for example, that facilitate this.

  24. par4 permalink
    December 17, 2009

    Great post Ian, at least we knowthe Dems have their priorities straight!

  25. December 17, 2009

    One must admire the Republican/”Conservative” propaganda empire, particularly the process by which Republican administrations bankrupt the country with debt every time they’re in office, then criticize the opposition for “spending” and “raising taxes” to balance the budget when they’re out of office. Unfortunately the logical thing for the Democrats to do in such a circumstances is to stop trying to balance the budget while in office.

  26. December 17, 2009

    Albatross: One must admire the Republican/”Conservative” propaganda empire, particularly the process by which Republican administrations bankrupt the country with debt every time they’re in office, then criticize the opposition for “spending” and “raising taxes” to balance the budget when they’re out of office. Unfortunately the logical thing for the Democrats to do in such a circumstances is to stop trying to balance the budget while in office.

    Bingo. Conservative know that deficits don’t matter. Dick Cheney: “Reagan proved that deficits don’t matter.” Except when Democrats are in power, that is.

    Robert Rubin convinced Bill Clinton that balancing the budget was the way to go. This meme has taken over as gospel in Dem quarters, even though it undercuts the Dem agenda and is bad economics, to boot.

    Government deficits and surpluses aren’t good or bad in themselves but only in relation to what the real economy is doing. It is almost never good economics to balance the budget or run surpluses. When the public desires to save, this reduces aggregate demand, If there is a trade deficit, too, this further reduces it. (The US pretty consistently runs a trade deficit, and this is a good thing economically for the US, because it is an exchange of real goods for paper, of which the US has an infinite supply.) When aggregate demand is below real potential to produce goods and services an output gap and unemployment are the result, which means a huge waste of capital, but human and non-human. Since business is not going to invest more when aggregate demand is weak, it is left to the government to pick up the difference in order to close the output gap and maintain full employment.

    The trick is to balance nominal aggregate demand with real output potential, thereby fully utilizing economic capacity and maintaining full employment, along with price stability. Inflation will occur if nominal aggregate demand exceeds real capacity. At that this point reducing the deficit and increasing taxes is called for. If inflation takes hold it may even be necessary to run a budget surplus for a short while. But if a budget surplus lasts too long, then this will drain the economy of net financial resources to the degree that people will have to go into debt in order to maintain their lifestyle. Running surpluses over a longer period of time will result in growing private indebtedness.

    The current preference is to manage “inflationary expectations” through monetary policy. This is based on the premise that there is a rate of unemployment of about 6% that is necessary to preserve price stability. This is called NAIRU (non-accelerating inflation rate of unemployment), and the monetary policy is guided by the Taylor Rule, which does not take unemployment into account, only price changes. Research shows that this presumption is, well presumptuous, and the reasoning behind chiefly using monetary policy instead of fiscal policy to achieve full employment and price stability results in a huge waste of capital, human and non-human in the name of price stability. Oh, by the way, inflation is poison to creditors like bondholders (AKA rentiers, coupon-clippers), so guess who gets preference here, instead of people who work for a living getting a fair shake.

    Progressives need to get this straight, or they will continue to sabotage themselves with bad economics. Even Neo-Keynesian liberals like Krugman are under the misapprehension, and Post Keynesians do not have a political voice because they have been marginalized by the elite in academia and politics, and the media pundits that reinforce this erroneous viewpoint. So you have to read their blogs or read their articles and books to get this perspective.

    The US will never get proper health care reform will these memes remain in place. And all social programs will be under attack until gutted. That’s the conservative agenda, after all. Progressives need to wake up and realize that their own economic ignorance is resulting in self-sabotage.

  27. December 17, 2009

    Oops. I didn’t close the emphasis after the end of the quote (first para). Ian, could you fix it. Thanks.

    Be nice to have a preview or edit option if the software allows it.

  28. December 17, 2009

    Re: Nate’s question 20 – Am I just noticing this tendency now, or has Nate been getting kinda snippy lately? He’s usually so technocratic.

  29. December 17, 2009

    Reminds me of the old days at FDL, tjfxh. Someone would forget a closing tag and we’d spend the next half hour arguing in italics, boldface, or blue.

  30. December 17, 2009

    And no one would be forced to buy the public option anyway, it’s an option. Only one of many choices.

    Right, although neither bill seems to encourage more competition among insurers. With a public option that was available to everyone, there’d be one more choice besides the two or three we generally have now, assuming nothing else about the bills was changed.

  31. December 17, 2009

    One important thing that hasn’t been noticed about “the public option.” Most people aren’t wonks and don’t follow the details. A whole lot of people who wanted the public option thought that they would be getting the choice of a public option themselves, when that was never true. This would have been a huge disappointment, and it should have been more widely publicized.

    Most people don’t keep up the the details and politicians know this. This is why the Dem Establishment figures it can pass anything labeled “reform” even though it is a sellout to the industry and is really the opposite of reform. That way they can take credit and the money, too. They really don’t much care as long as they continue to get reelected.

  32. Ian Welsh permalink
    December 17, 2009

    Guess I’m not a progressive. I want the House bill killed too, if it isn’t improved. Because it’s a pile of crap, with a public option to weak to control costs either.

    But clearly, in context, I was referring to the Senate bill, since the “kill the bill” movement is about the Senate bill, so no, it wasn’t incorrect unless you are determined to read it that way.

  33. December 17, 2009

    tjfxh;

    A whole lot of people who wanted the public option thought that they would be getting the choice of a public option.

    Yes, that’s why I specifically wrote “available to everyone who wants it”. That’s what was needed for it to be useful, in my book. If it’s only offered to people who can’t otherwise get insurance, which is what the House bill does, it’s not going to keep the insurance companies honest.

  34. December 17, 2009

    Ian:

    Guess I’m not a progressive. I want the House bill killed to,

    Guess I’m not, either. If the House bill had a viable public option – available to everyone, able to set its rates as Medicare does, and available as soon as the mandate was in place – I could live with it, although there’s lots else that’s bad. As it is, though, I think it’s not worth passing, either.

    What I find interesting is how much it took for the bulk of the progressive community to believe that the Senate bill wasn’t worth passing anymore. And if Krugman’s blog today is any indication, there are still lots of folks out there who still don’t get it.

  35. December 17, 2009

    The House bill as it stands is dead, too, if it becomes a matter of reconciliation. The rules do not permit passing comprehensive legislation with reconciliation. Reconciliation is limited to budgetary items.

    Separate measures will have to be put together for reconciliation. This gives progressives an opportunity to put some real reform into the system without all the crap that came along with it in both House and Senate bills, although under reconciliation the options are are limited to budgetary items alone and expire in five years.

    The choice now is between either the Senate bill or going to reconciliation. The Democrats know that they have to pass something, or it will be obvious that they are incapable of governing. The voters would rather have a bad government than a government that is incapable of governing. That is only good for the GOP because they’ve demonstrated that they can get things done, even if they are the wrong things.

    Moreover, if the Democrats don’t pass anything, President Obama is a lame duck. He’s finished as far as getting any other big program passed. This would be a catastrophe for Democrats and they know they have to avoid it at all costs.

    So Team Obama is going to try to get the media to paint this as the president’s Sister Soulijah moment, “standing up to leftist extremist.” The “leftist extremists” in Congress need to give him the finger, play hard ball, and negotiate a deal that will not be a poison pill for Democrats. The president needs to be put on notice that “bipartisanship” is over, because it never was in the first place. Politics is always cage fighting in suits.

  36. Ian Welsh permalink
    December 17, 2009

    Then I guess Dean wants to kill the House bill too, eh.

    Reconciliation can’t pass everything, but it can pass a lot. Including a Medicare expansion.

    Up to the President, Sanders and Burris at this point.

  37. December 17, 2009

    “Guess I’m not a progressive”

    Progressive, shmogressive.

    The GOP is now a right wing extremist party. What is need to oppose these arch-reactionaries is a bunch of left wing radicals.

    These people are much more dangerous to America and American values than Emperor Richard (Nixon) or Saint Ronnie (Reagan) and their cronies. These folks aren’t only fine with torture, they don’t even shy away from talking about secession (treason) if they don’t get their way.

    As I said, this is a cage fight. The old labels are obsolete now. The left needs real activists.

  38. December 17, 2009

    “Then I guess Dean wants to kill the House bill too, eh.”

    Yes, this is what Gov. Dean said on KO last evening when he called for killing the Senate bill and going to reconciliation. He talked about passing a number of separate measures instead of a bill, which is not possible in reconciliation.

    Of course, this limits what can be done. But progressives can pretty much manage the process instead of being taken for granted and rolled. The activist base needs to have their back and make enough noise to make the progressives a force to be reckoned with at the voter level. Team Obama needs to wake up and realize it needs its grassroots activist base and it can’t take it for granted any more. The honeymoon is now officially over.

    The president, his advisers, and the Congressional leadership blew it by losing control of the process. They should have walked it through step by step, making sure that they had the necessary votes for everything as they went, and were keeping the votes as the process developed. Instead, they handed the process to people essentially in the employ of the insurance and pharma industries. One can only conclude from this that they were incredibly naive politically (which I don’t believe), or else, they had made a deal with insurance and pharma and the rest was kabuki (which I strongly suspect). So the left is not just opposing the GOP here, but the Village (AKA the Empire). This is going to take some doing because I’m afraid the president himself has sold out.

  39. December 17, 2009

    BTW, anyone who hasn’t yet read or seen Keith Olberman’s Special Comment on health care “reform,” should definitely take the time. He’s got Howard Dean’s back big time. It’s available here.

    http://www.msnbc.msn.com/id/34455168/ns/msnbc_tv-countdown_with_keith_olbermann

    I can just imagine how the WH is apoplectic over this.

  40. Celsius 233 permalink
    December 18, 2009

    ^ Thanks for the link; Olberman has a lot of mouth; will he back it up? I think he’s safe because this bill is doomed. The loudest sound coming from America these days is the sound of a giant flush. What a hopeless bunch of pussy’s.

  41. Scott R. permalink
    December 19, 2009

    Once again I say…, that there will be a bill passed…, regardless of what the Dem’s do. If Wall Street and Health Insurance have to hold a shotgun to the heads of a couple of Republicans to get the votes to pass mandated coverage…, they won’t hesitate to do so. Don’t be surprised when a couple of Republicans suddenly get a conscience and vote to “help out those without healthcare insurance”. Obama sold out long ago…, and even if there are a few Dem’s who haven’t…, they won’t be able to stop it.

    http://www.pbs.org/moyers/journal/12182009/transcript4.html

    BILL MOYERS: Let’s start with some news. Some of the big insurance companies, Well Point, Cigna, United Health, all surged to a 52 week high in their share prices this week when it was clear there’d be no public option in the health care bill going through Congress right now. What does that tell you, Matt?

    MATT TAIBBI: Well, I think what most people should take away from this is that the massive subsidies for health insurance companies have been preserved while it’s also expanded their customer base because there’s an individual mandate in the bill that’s going to provide all these companies with the, you know, 25 or 30 million new people who are going to be paying for health insurance. So, it’s, obviously, a huge boon to that industry. And I think Wall Street correctly read what the health care effort is all about.

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