Well, now Matt Taibbi is saying it, maybe progressives will listen:
In the end, the Blue Dogs won. When the House commerce committee passed its bill, the public option no longer paid Medicare-plus-five-percent. Instead, it required the government to negotiate rates with providers, ensuring that costs would be dramatically higher. According to one Democratic aide, the concession would bump the price of the public option by $1,800 a year for the average family of four.
In one fell swoop, the public plan went from being significantly cheaper than private insurance to costing, well, “about the same as what we have now,” as one Senate aide puts it. This was the worst of both worlds, the kind of take-the-fork-in-the-road nonsolution that has been the peculiar specialty of Democrats ever since Bill Clinton invented a new way to smoke weed. The party could now sell voters on the idea that it was offering a “public option” without technically lying, while at the same time reassuring health care providers that the public option it was passing would not imperil the industry’s market share.
The public option, isn’t. As I noted quite some time ago. It will not reduce costs, it is questionable that it is even viable. And yet progressives are going balls-to-the-wall for a non-viable public option which won’t even reduce costs rather than, at the least, fighting for a real public option?
Folks, you are being sold a bill of goods. The people shilling for this version of the public option, whether politicians or others, are shilling for something that won’t work (not that even a nominal public option is likely to be in the final bill).
The best thing that can happen, at this point, is for nothing to be passed. Because right now it looks most likely you are either going to be forced to buy insurance without an option to buy a government plan, or you’re going to be forced to buy insurance with the possibility of buying government insurance that’s no cheaper than private insurance, and which may not even be able to stay in business (it does have to succeed without any subsidies.)
Or Obama can lead. He can say “Enough. You tried, you failed. We will expand Medicare to all.” Then the Republicans have to run against Medicare, and if they do that, they’ve lost. Medicare is the most popular government program aside from Social Security, and anybody running against Medicare is taking on old folks as well as taking on something that’s already a known quantity. You can’t say Medicare has “death panels” because it doesn’t. You can’t say Medicare rations care, because it doesn’t — it won’t pay for everything, but you can always buy Medi-Gap coverage from private insurers for the things it won’t pay for. And the bill would be literally 5 pages long, most of which would be boilerplate around the three paragraph payload, one paragraph expanding Medicare to everybody, the second one which raises the Medicare payroll tax to 4/4%, the third which adds a 5% Medicare surcharge to the income tax for everybody who makes over $500K/year. I’ve worked the numbers and that would pay for every dime that’s currently being paid through private insurance, and leave enough to cover the current uninsured. Three paragraphs. That’s all it would take.
But yeah, that’s not happening. So… get ready to pay out for insurance you can’t afford, with co-pays so high you can’t afford to use it even after you’ve been forced to cough up for it.
Plus ca change
tc
How reassuring to know the thing they won’t let us have was worse than what we have and almost as bad as what we’ll get.
tjfxh
In the end, this is going to work to provide better services and reduce costs, or not. If it doesn’t, then it will fail, and the Democratic establishment will fail along with it.
It’s looking increasingly like reform is going to fail. The fact of the matter is that it failed before it got out of the gate because deals were made with people who provide the campaign money.
Paul B. Farrell-MarketWatch: Deocracy is dead
This is bad for the country but maybe it will energize progressives to work harder to wrest power in the Democratic Party away from the Villagers. The extreme right took over the GOP. The left can do the same in the Democratic Party over time if it is sufficiently motivated by deteriorating conditions. And deteriorating conditions are on the way. There is going to be a populist revolt, and we had better hope it is from the left. If it comes from the right, it’s virtually certain there will be a monumental war.
vastleft
Doubtless, the blogosphere A-list and big activist groups like MoveOn will do extensive soul-searching about their role in promoting — at the expense of single-payer advocacy — the mushy target of “public option.”
They’ll also beat themselves up over their snooze at the switch when Obama and his minions took single-payer off the table, in flagrant betrayal of promises of an “open and transparent” process that would consider all options.
Apologies to the Cassandras will be issued.
And bonobos will fly out of my butt.
Calvin Jones and the 13th Apostle
There is going to be a populist revolt, and we had better hope it is from the left. If it comes from the right, it’s virtually certain there will be a monumental war.
And who is going to lead it from the right? Glenn Beck wouldn’t have lasted a day in Vietnam or WWII.
tc
It’s time for preznit jujitsu to turn the fury of the right wing mobs against our common enemy, the corporatis… oh yeah, he’s one of them. Guess it’s time to punch the hippies some more.
tjfxh
And who is going to lead it from the right?
I suspect that the same people who gave us W will pick a Curits LeMay or Alexander Haig type general. Don’t underestimate this threat. There are a lot of confused, angry, and desperate people out there and when things get worse economically, as it seems they will, or even just continue to stagnate, many will be looking for a strong authoritarian figure. There is also the very real possibility of an exogenous shock, like another attack on the US. It’s hard to put a probability on these things but it’s not minimal.
Cujo359
The “public option” as Taibbi describes it doesn’t meet anyone’s definition of a useful public option. If that’s what comes up for a vote, it should be voted down by progressives, and may be.
As fraught with problems as it is, the public option has been more popular in polls that have been pointed out to me than any form of single-payer. Even with 65+ percent support (depending which poll), the public option isn’t happening. Single-payer requires that people give up their insurance for an unknown. While many would be glad to do that, many others won’t. If you depend on something and it works for you, you’re a whole lot less eager to give it up than if you think it sucks. That’s particularly true when your health or your life is involved.
Even so, the public option is in trouble. How could single-payer have done any better? So far, I haven’t seen an adequate answer to that question. The fact is, we don’t seem to have the numbers in Congress to make either happen. The best we can do right now is make sure something bad doesn’t happen. Sad to say, but true.
tjfxh
The best we can do right now is make sure something bad doesn’t happen.
The problem is deciding whether health care and insurance are luxury goods or public utilities (privilege vs right). So far, the winners in the debate are that health care and insurance are luxury goods (a privilege of wealth and success). There is no way to get a good plan with this attitude prevailing, without the administration and the congressional leadership not pushing back against it strongly. They aren’t.
Without treating health care and insurance as public utilities, the attempt at reform is going to be misguided. The purpose of insurance is to reduce economic risk. The principal economic risks are two, (1) cost of health and and insurance rising at about 10% a year under the present system, and (2) cost-cutting on the part of insurance companies through denial of coverage and claims.
There is nothing in the plans being put forward to cut costs, only to shift costs, e.g., from Medicare and Medicaid. Of course, this is covered up by blather about savings from efficiencies that seniors aren’t buying, and the poor have no voice. Moreover, preventing the insurance companies from doing what they are doing will only increase the cost of insurance without a universal mandate that will result in a political backlash.
The present way of dealing with this is a hodge-podge that is sure to fail even if it passes. There is no way to get a “good” plan past the moneyed interests who already extract 16% of GDP and are shooting for 20%. The only way to start is by cutting this extraction of rent as a hidden regressive tax, and the only way to do that is by taking it out of the private sector and paying for it through government taxation instead of rents as hidden taxation going into private pockets. The math is really pretty simple. Without taking the fluff (rent) out of the system, real reform is not possible. And that’s not on the table.
Mandos
Haha, vastleft is learning the lesson that Nader supporters learned long ago.
Mandos
So this gets down to the point. The common denominator in all of this. The basic requirements of any reform effort is that the profits of existing rent receivers in this current system be fully preserved and guaranteed in the next.
So, given this immutable requirement, what reform options exist?
DWCG
If not Medicare for All, give us at least Medicare for Anyone Who Wants It, specifics here: http://www.dailykos.com/story/2009/9/6/776943/-The-ONLY-Robust-Public-Option-is-Buying-Into-Medicare
Instead of being out there peddling a “public option” we could have simply been saying, we’re going to give the public the option of buying into Medicare.
But I think we’re all mistaken if we don’t believe this bill is right where Obama wants it. His real fight is with the public, who actually do want something better than an insurance industry bailout and Big PhRMA giveaway.
DWCG
If it doesn’t, then it will fail, and the Democratic establishment will fail along with it.
Mandating the public buy overpriced junk insurance from the very industry we hate the most is a pathway straight to the political graveyard.
Of course no Republican would dare put their name on this bill. They’re going to be hammering Democrats for it for the next generation!
selise
i think this is why paul wrote:
Mandos
But at this point we come to the paradox. The only thing that will get done is what is politically acceptable. But nothing will get done in truth if it is politically acceptable.
A logjam.
tjfxh
But at this point we come to the paradox. The only thing that will get done is what is politically acceptable. But nothing will get done in truth if it is politically acceptable.
Welcome to plutocratic oligarchy masquerading as liberal democracy. The folks at the top have captured the state and the status quo will continue to prevail as long a legalized bribery in the form of campaign finance and lobbying are permitted. The reality is that no one can win a general election without the financing provided by the deep pockets, and all politicians know this. Obama had heavy backing from Wall Street and delivered trillions as soon as he took over. The deal on health care reform is already sealed in the sense that the industry has indicated what it will accept and what it will not accept. Those are the parameters of debate.
The deals are done in private and the rest is merely theater that provides dramatic interest. The public likes a good show. Bread and circuses, you know.
Jeff W
What little good I can see coming out of this colossal mess is
(1) “Been there, done that”: If something called a “public option” was supposed to be a sort of acceptably safe “middle ground” between whatever it is we have now and a single payer system, it turned out to an abysmal, chimerical failure. This whole sordid episode exposed the fallacy—or, perhaps, charade—that “competition,” the point of Jacob Hacker’s original proposal, was the underlying requirement to be maintained in any reform effort when, in fact, the underlying requirement was, as always, as Mandos beautifully put it, “the profits of existing rent receivers in this current system be fully preserved and guaranteed in the next.” Hacker got suckered by the espoused values of the system and his “public option” got hammered by the actual values; and
(2) The “parameters of the debate” are fully exposed, it seems. It’s gotten at least a little harder for the oligarchic plutocracy to pull off the masquerade. If we’re in a box, at least we know we’re in a box.
Ian Welsh
“So this gets down to the point. The common denominator in all of this. The basic requirements of any reform effort is that the profits of existing rent receivers in this current system be fully preserved and guaranteed in the next.”
Nothing meaningful as long as this is the case.
Ian Welsh
Cujo: public opinion is not that meaningful in the US political system. The majority of people wanted out of Iraq in 2006 and voted for a Congress that wanted to do that, and it didn’t. The majority want a public option, but the majority also want single payer, but that isn’t on the table, and so on.
Single payer would be harder to demonize, because Medicare is popular and the teabaggers mostly love Medicare, but either a robust public option or single payer could probably be passed, under reconciliation, if Obama and the Congressional leadership wanted that. Certainly either could have been passed if it had been done in the first couple months of Obama’s term.
You aren’t still in a functioning democracy, you’re in a representative plutocracy, where politicians deliver voters to billionaires and large rich interests.
tjfxh
Jerome a Paris has a good dairy on this over at DKos, breaking it down into parties to negotiation.
Negotiations 101
Cujo359
public opinion is not that meaningful in the US political system., etc.
Then there’s no point in discussing all this. If it’s all up to other people, why even consider what we want?
The reality is there are various forms of “no”. There’s “I don’t think so”, and there’s “no fucking way”. When it’s more like the second, that’s worth considering, even if you’re a plutocrat.
Mandos
I hope everyone realizes just now insidious mandates are. In a world in which corporate interest defines the politically possible, the only way of changing political possibilities is to increase the cost of non-compliance with progressive demands for corporate interests. When it comes to insurance, the only way to increase costs is not to buy insurance—a consumer strike.
Since no one wants to go without insurance voluntarily (regardless of claims about the uninsured being all reckless young people), it is merely the unaffordability of insurance that creates a consumer strike. With a mandate, consumer strikes now become an act of civil disobedience to the state.
ballgame
FTR, most of the comments here strike me as being rather depressingly accurate. Also, FTR, I’ve been an avid supporter of single payer for decades and remain one today.
I would like to take issue with one point that’s somewhat technical but not minor. It appears to be an article of faith among many that if the rate of the increase in spending on medical care is rising above the rate of inflation, that’s a sign that something is wrong.
But there’s no reason to assume that this is the case. Two combined dynamics are naturally propelling increased spending on medical care: the advance of science and technology which allow us to address medical conditions which used to be untreatable but are now treatable with effort (i.e. spending), and a rapidly aging population which is increasingly subject to physical malfunction. The goal of arbitrarily ‘reducing spending on health care’ (i.e. ‘reducing medical costs’) makes no sense given these two conditions.
Now, I completely agree that the private health insurance industry is a parasite leaching off an enormous amount of badly needed funds which should be going towards medical care instead of feathering shareholders’ pockets. And there’s no question that we can’t indefinitely increase the share of our resources going towards medical care. I’m merely pointing out that devoting an increasing percentage of one’s economic resources towards medical care is not inherently emblematic of economic irrationality given our underlying demographics.
Mandos
I tend to agree with you, ballgame. The correct measure is the fact that other countries are spending far less for at least similar outcomes, and often better.
Ian Welsh
Yes, Ballgame. Even if you went to single payer the fact that medical costs are increasing wouldn’t end, but it would probably stall for a decade, then rise again, or at least rise a lot slower for a decade.
Canada has health costs, inflation is killing us too, but it’s doing so from a much lower base cost.
Single payer is the dead easy money. We know how to get it. The hard money comes in changing how people eat, exercise and the environment they live in. But that won’t be tackled properly until the US government is on the hook for their medical expenses.
BDBlue
Not just changes in how people live, but how the medical establishment works will eventually need to be addressed. Some doctors care deeply about their patients, some care deeply about their profits.
Ian Welsh
Yes, a lot of that gets fixed in single payer though.
BDBlue
We also need a complete revamping of food policy. It’s easy to lecture people to eat right, but it’s hard to do when burgers are cheaper than produce (and I know you know this Ian, so I’m not referring to your comment as an example of this tendency, I’m thinking more about Obama’s – and other neoliberal’s and conservative’s – tendency to emphasize personal responsibility while ignoring the restictive choices facing these folks because of larger decisions made by the government, usually to help some corporate sponsor).