The horizon is not so far as we can see, but as far as we can imagine

What Failure of Health Care “Reform” Will Mean


And maybe I’m being unfair, but I don’t seem to see the same degree of soul-searching on the other side. Too much of what I read seems to come from people who haven’t really faced up to what it will mean for progressive hopes — not to mention America’s uninsured — if health care reform crashes and burns, yet again.

What it will mean is not forcing people who can’t afford insurance to buy insurance they can’t, well, afford.  And bad insurance at that.

I think the Raven nails it when it writes:

I’m struck, in reading the support for the disastrous Senate “health” “care” bill, how much it depends on the idea than an improvement on the average level of US health care is acceptable, even though it means that huge numbers of people will be ruined, and some will die. And I think I’m starting to see a pattern: among liberals the academics and the people with secure jobs support it (even Krugman, sigh), and the people like Ian Welsh who’ve actually been poor, or who know people who’ve been poor, oppose it. It’s easy, when dealing with numbers, to forget that each click on the counter signifies a whole life: hopes and fears and dreams. I want us to remember.

A whole life and all its fears and dreams.  How many will be destroyed by this bill?  I won’t pretend that politics shouldn’t be about doing the most good for the most people, but sometimes the price in destroyed lives is too high for marginal improvement in other people’s lives.  (See reduced consumer costs in exchange for making people unemployed, aka: “free” trade.)


I’m with Johnny


Better to pass a bad bill than no bill?


  1. Tim McGovern


    Given the dire corporatism we’ve been fed, and all the talk about the nice academics/A-listers who’ve taken the bait about those nasty Rasputins, I’m fully up on this whole quasi-revolt (not like there’s too many non-net protests or nothin, Africans at Copenhagen notwithstanding). I agree wholeheartedly with you, Ian, with the heart of this post that those who have been poor before (or, as importantly, spurned/rejected from the plum jobs of the elite world) actually know what they’re getting into with the mandates-with-no-benefits. The reappointment of Mr. Epic Fail, Bernanke, is another case in point, as is the 1/3 tax cut stimulus, or the talk in the half-assed jobs bill about small business tax games, err, credits. Not even going to mention civil rights.

    But, as you’ve said before, as does Matt Cale at the much less ‘respectable’ (but no less funny and apt, as is/was the eXile, old home of Matt Taibbi) Ruthless Reviews, this fight is just one of many that Obama has thrown, after having so much political capital. As he and you have pointed out, Obama had an organization so ready to march according to his whim – which I had the bad sense to figure was to cut off the balls of any pissant Senator who crossed him when it came time to enact his reforms, as kinda conservative (cautious, not Palinesque, as you say) they may have been – that I thought the Liebermans of the world would have to STFU. The spending of lobbyists to stop all this is proof enough of this simple fact, that Obama held the reins and could have LBJed his way around with organizational money, stumping, etc. Besides, most of the official media loves the guy, and I hoped that the pedestal they’d of course want to push him off eventually would endure, especially after the absolute nuttiness and (potentially and real) violence the Right has responded with. Instead, Obama responds to ‘MARXIST NAZI KENYAN’ with an even more watered-down neoliberal, disproved crap than Clinton – with no results. He let his people pray to Santa Jesus and hope for the best, and let the money power create Tea Parties in order to shift blame to him for all the bad shit that got him his big win in the first place. Strategery of the highest order.

    I guess when one is floating so high off the ground in Powerstan that the Church of the Savvy is the only link to truthiness that matters. The guarantee by all the news stations – strike that, I mean the AP, which is the newspaper for national affairs for every local paper in the country – that ‘this bit of news is sure to help the Republicans’, along with the fact that every single piece of regular news had the ole fair and balanced vibe, that Obama has been driven, nay, forced, to accept this set of circumstances. From climate change to stillborn economic orthodoxy like Alan Greenspan’s confession, to outcast Paul Volcker’s asskicking (which I’ve seen covered in few enough places), then the only real choice for good lefties who might stay home is to eat the shit and be happy Sonia Sotomayor is still there to… well, I guess we’ll see.

    Just look at the backlash of still-good sites like TPM, who I think are, with their reader updates, pretty much printing astroturfed Obama aides’ comments where the writer has a precondition and wants the bill that, well, doesn’t do what he/she wants it to do. Though I could very well be wrong about that, the gist of his site of late, since you (who I noticed Nate Silver hasn’t acknowledged yet – maybe get FDL to post your response as well?) has been as a cheerleader of ‘pass it and clear it up in conference’.

    Well, something like that, I heard it involves free ponies for those with care costing more than a set limit. And a jet ski. You see, Obama got huge contributions from the jet ski industry.

    Anyway, sorry to rant so long. I only wanted to say that you’re right, and that, given the other ridiculously massive, complicated fixes to the U.S. we have left to do, the progressive caucus has to nut up and stand up to this bullshit now. Financial reform, climate change, green policy that isn’t a bubble – or hell, is one, but an actually useful one that can’t be gamed, like you and Stirling have been talking about since forever – that just cannot be accomplished with the conventional wisdom in D.C. being ‘go Blue Dogs and GOP, libs are pussies’. It’s now or never, and Chris Bowers’ talk about it being a bad thing for 2010, etc., if we shoot this down over – gasp – principle! Is nonsense. The spin has long since left the building, since Obama has long since abandoned his post. Was it you who talked about the ‘swing money’ bet by the Dem elite? Well, let em chase that if they want people to die. If the progressive caucus stands up, maybe they’ll finally be allowed on TV to make the truly liberal case, and the low-info voters who love tea parties might be forced to think about something that’s more real than the latest CGI techniques employed by James Cameron. Otherwise, it’s this, this terribly long, predictable, and especially evil healthcare debate over, and over, and over- and over again. Rinse, repeat, redux. I heard the director’s commentary by the Daves – Axelrod and Plouffe, are fantastic.

    Much loved your latest podcast with Jimbo.

  2. Raven’s thought occurred to me as well. If you’ve never been poor, or known people who were poor, then it’s probably hard to imagine what the problem is. In fact, you don’t even have to be poor, per se. All you have to be is someone who has to make decisions about the necessary things in life.

    I find it hard to believe that Krugman can’t figure out what a poorly-regulated mandatory insurance scheme means. I can only assume he can’t imagine what it’s like to have to decide whether you’re going to buy a new set of tires or pay this month’s insurance. That’s the kind of choice people will face, and that’s as potentially life-or-death as not having insurance.

  3. anonymous

    Good point, even though I can’t claim to know what is left in the bill that is any good, all I can see is a huge risk on the downside (mandate) and some very weak tea on the upside. Like buying a $1000 lottery ticket when the potential winnigs are only $1010.

    Having been poor and uninsured, I would be very upset with the mandate to buy insurance if I was poor and uninsured now. I had no insurance between ages 18 and 33. And now that I supposedly have the good federal employee health benefits plan available to me, I find using Blue Cross Blue Shield so expensive and so much trouble that I generally prefer not to get check ups or to do anything else. I mostly have it for horrible emergencies. BC/BS still means finding preferred providers (even finding preferred providers who use labs that are also preferred providers, OR ELSE you can count on paying most of those costs out of pocket). Then you have copays out the wazoo, sometimes unexpectedly (like showing up for minor surgery after being told by the surgeon that there is no copay, but the surgery center has other ideas when you get there and want $50 cash, and you were just lucky that you had gone to the ATM the night before). And then for months you get endless statements that are incomprehensible and bills for a hundred bucks here and and hundred bucks there that the insurance wouldn’t cover and the doctors expect you to pay, even though you were told otherwise before… It’s endless. Sometimes I contemplate dropping my insurance just to spite the insurance companies.

    If what I have is good or at least fair-to-middling insurance, I’m sure the subsidized insurance available under the mandate will be an unmitigated disaster for patients. If you get bankrupted because of $50K of medical bills under the new law (instead of $75K under the old system) you are still bankrupt. The only difference is that the medical industry will squeeze an extra $25K of blood out of the stone. And they will expect you to help them collect that $25K or send the dogs of the law or IRS after you for fraud or some other civil infraction if you don’t.

    And here is the big danger here: once we have the mandate, we are stuck with it. It is a progressive tax imposed by the govt but payable to private industry. The Blue Dogs and the Republicans will never let us out of that part of the bargain, and the rest of the Dems would be too timid to try, anyway.

    GOD BLESS HOWARD DEAN. I hope he primaries Obama’s quisling ass. YEARGH!!!

  4. anonymous

    Er, I meant a “regressive tax”. But I guess it’s kind of a pun as written, since the progressives will get all the blame for it.

  5. New Rule: No one making over $200,000 a year is permitted to comment on the health care debate (because they haven’t got a clue personally).

  6. It gets better by the minute. Now Ben Nelson says he will filibuster until he gets a stricter abortion amendment attached to the Senate bill. This bill becomes more and more politically poisonous for Dems every hour.

    Let’s see now. How much is the women’s vote worth in comparison with the campaign cash from the insurance companies and the open revolving door when you leave office? That’s the 64 dollar question.

    What a farce.

  7. anonymous

    So how hard would it be to strike out the abortion restrictions in conference? If they do it right, there are no fingerprints when stuff goes in or comes out in conference. That said, I hope Nelson kills the bill and Obama has to wear this rotting fuck up around his neck for the rest of his one term presidency.

  8. Does this mean I don’t get a pony?

  9. S Brennan

    Look, I don’t cut a lot respect around here, but I did come up with:

    “Obama is Bush’s 3rd Term”

    After FISA…and I think it is a pretty good slogan, a good shorthand phrase to explain a lot of things quickly, but above I saw a phrase my dad would be proud of:

    “Obama’s quisling ass”.

    “Obama’s quisling ass”.

    “Obama’s quisling ass”.

    You gotta like the sound of that phrase, it explains/expresses the source of anger quickly.

    Remember “quisling” is not about personal betrayal, it is about being a traitor to one’s country. Good one Tim!

  10. Jim

    Ian says, “ How many will be destroyed by this bill? …sometimes the price in destroyed lives is too high for marginal improvement in other people’s lives.”

    This bill and those who support it do not speak for the needs of the poor. For the most part , Congress does not speak to the needs of the unemployed, the underemployed, the dispossessed. They don’t have a voice! Who will speak for them? Who will fight for them?

    These poor, unemployed, underemployed, dispossessed are the ones whose demands are not being met within this system; the health insurance bill is yet another proof of that. They need health insurance, can’t afford it. They need education, can’t afford it. They need housing, can’t afford it. They need utilities, can’t afford it. They need food, can’t afford it.

    Does this signify the end of the safety valve that the working class fought for and the progressives in the government supported ? If it does, then how will their needs be met?

  11. I find it hard to believe that Krugman can’t figure out what a poorly-regulated mandatory insurance scheme means.

    He’s undoubtedly able to figure it out, but I don’t think he feels it. Which is my point.

    And thanks very much for the link, Ian!

  12. Celsius 233

    What I hope it will mean is; the quiet people, the poor people, the used-to-be middle class people will get off their apathetic, greedy, selfish, uninvolved asses.
    There is only one thing that gets attention; going to the streets. That’s it, period.
    If we hit double dip; then it might happen, but I doubt even that will do it.
    There is some “thing” fundamental, missing; some “thing” lost, from the American psyche.

  13. I don’t know what kind of health care reform will come out of this session, but I strongly suspect it won’t be much. There is, however a silver lining behind this very dark cloud. I am reminded of the Civil Rights Act of 1957. Don’t be embarrassed if you’ve never heard of it, there really isn’t a hell of a lot to remember about it; a mere pittance, really – a scrap of leftovers tossed out to “American Negros” (in the parlance of the age) in order to appease them. But it made the passing of the Civil Rights Act of 1964 – the one we remember – all-the-more easier seven years later.

    We’ll live to fight another day.

    Tom Degan

  14. Lex

    “Does this signify the end of the safety valve that the working class fought for and the progressives in the government supported ? If it does, then how will their needs be met?” ~Jim

    It may well. Their needs will be met if/when they unite to take care of themselves and each other. And it’s the second bit that’s most important.

  15. marcopolo

    I remember when I first found out I was HIV+, back in 1991, I had no insurance, so I ended up going to alternative medicine practitioners; I knew I couldn’t afford the clinically proven stuff. And even the alternative medicine was really expensive. Finally, moving to Boston with my job, I found out I could sign up for clinical trials, and at least get some free treatment that way. Eventually, Massachusetts changed its laws to allow (/oblige) guaranteed issue, community rated HMOs for anyone who had a job. I don’t know how long that had been available, but I found out about it in the mid-90’s through an organization called Health Care for All. What a relief! It’s scary to have a chronic illness and not be able to treat it. For a while there I was just waiting for my immune system to fall apart. I remember having a brief and frank discussion with my father about how treating me if (/when) I got seriously ill would ruin his retirement and eliminate whatever he hoped to leave to my brothers. I hoped (to myself) that I’d have the guts to do away with myself to avoid all the needless suffering and causing financial ruin for my family.
    I don’t mention this here to attract sympathy, only to point out that what I took away from all that was that the laws didn’t change because insurers willingly opened up their doors to people with preexisting conditions. They did it because good people pushed them to do it. A conspiracy of people with kind hearts and evolved social consciences got it done. I’m the (well…a) beneficiary of their work, patience and courage.
    And…right now I think we have to kill this bill because if we don’t, we’ll have to wait longer to get real reform than if we started from scratch next year. I think there’s momentum behind this issue in a way that there was not in 1990 (or whenever that was). If nothing else, the rate at which premiums are rising will force us to change the system. My premium was going up 18% this year, so I had to downgrade to a plan with a higher deductible. The resulting premium is only 10% higher, and I’m hoping I won’t have to spend that much out of pocket. We’ll see. I know I’m not alone. There are lots of people in my position, or worse. It shouldn’t have to be this way. I’m hoping that as health care gets more expensive, people will start giving single payer another look. I know a lot of Europeans and this is a source of anxiety they simply don’t have to put up with. Here’s hoping they either kill this bill or strip it of the mandate to come back in 2010 with comprehensive and cost-effective reform!

  16. anonymous

    Thanks for the kudos, S Brennan. And here I thought I was “anonymous”. Is my cynicism really so identifiable, or are you just very clever?

    I used to call him Obama ben Lieberman all thru the campain, and even though the name becomes more appropriate every month, for some reason that one never caught on (I don’t think I was the one who first made it up, but I did change the “bin” to “ben” to make it more Hebrew than Arab, since that offended so many delicate sensibilities)

  17. Jim

    “It may well. Their needs will be met if/when they unite to take care of themselves and each other. And it’s the second bit that’s most important.”

    Lex, I totally agree with your point. I remember when I first read “Workers of the World Unite.” It made sense to me then and yet, one hundred plus years after it was coined, it has not happened. Maybe, just maybe, the objective conditions for that unity are in the works.

  18. Tim McGovern

    Wasn’t it someone in Ian’s circle that invented the quisling insult? Him, or Stirling, I can’t remember. Same might go for Versailles.

    It’s the first time I’ve seen it as a reference to Obama, but I don’t know the entire Internet, so who knows?

    And yeah, S Brennan, it was anonymous, not me. Though I have used quisling on the ole BOPNews and other places. Much love to Brennan.

  19. anonymous

    Now I see S Brennan was talking to Tim McGovern. I thought he discovered my name (which is also Tim).

  20. Mason

    This is pretty close to loan-sharking. On the surface it’s helping the poor get access to insurance, but in the details it just tightens the insurance stranglehold. Does the White House really think that the public won’t figure this out?

    Tom Coburn made a instructive statement on C-SPAN recently: “Constituents always hold you more accountable for what you vote for than for what you vote against.”

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