And so we lump it

This is true for lots of projects from the outside looking in. I know that some of the more systemic issues in my own business come from making accommodations to the compromises made by those who set policy.

And Carper is among those making policy. VC probably has it right that he is likely more of wet rag than anything, but I think that giving someone the privilege of representing me in Congress comes with it some obligation to leadership.

I’m very much aware of the need for 60 votes. But I’m also aware that this is 60 votes for a very compromised already bit of business that has some good stuff in it, but its long term impacts are the ones that get traded away for short-term interests that have not one darned thing to do with getting this reform — as policy — in place. Everyone says that you do not really want to see laws being made and this process is likely Exhibit A. But that doesn’t mean that it is any easier to watch as the groups with money to burn are enabled by the people whose campaigns they finance.

Sent his kids to public school; has lived in same house for 20 years; saved $$ with modest lifestyle; one of the kids goes to a fine state college; spouse who worked for DuPont. The Thomas Stanley recipe, http://www.nytimes.com/books/first/s/stanley-millionaire.html and a talented wife.

A minimum medical loss ratio for insurance companies mandating that they spend at least 90 cents of every dollar they take in as premiums on health care. This is based on the crazy idea that health insurance should insure people’s health instead of corporate profits.
Turn all health insurances companies into non-profits. Most countries that are not single payer (Switzerland, Germany, Belgium) require all basic health insurance plans to be non-profits.
On the new exchanges, create a much stronger risk adjustment mechanism, like in the Netherlands, to encourage competition on quality and cost effectiveness, instead of the cherry picking of healthy customers.
Allow undocumented immigrants to buy health insurance on the new exchange with their own money. It will increase the size of the risk pool and reduce the cost of uncompensated care in this country.
On the new exchanges, use more tightly defined benefit packages, and define plan levels based on deductible and copay size, instead of actuarial value. This will simplify comparison shopping and encourage the selection of more cost-effective HMO’s, instead of PPO’s
Allow for drug re-importation. People in every other first world country pay much less for the same prescription drugs. Let Americans buy these cheaper drugs from Canada or Europe.
Allow Medicare to directly negotiate lower drug prices. Medicare Part D was one of the biggest corporate giveaways in American history. Allow Medicare to use its size (as the VA system does) to directly negotiate for lower drug prices for seniors.
Eliminate direct-to-consumer drug advertising. It only increases the unnecessary use of medicine.
Follow the FTC recommendation by providing shorter exclusivity periods for biosimilars. The current bills create an extremely long 12-year exclusivity period. Going with the FTC recommendations will increase the availability of much cheaper generic versions of life saving biologics.
Create a robust public option that can use Medicare rates and Medicare’s provider network.
Create a single provider reimbursement negotiator like basically every other industrialized nation. The lack of this is the single biggest reason why, as a nation, we pay several times what other countries do for the same procedure.
Create a fully integrated, government-run health care HMO, based on the VA health care system, which would be an insurance option for all Americans.
Finally, adopt a Medicare-for-all single-payer system for everyone in the country.

http://fdlaction.firedoglake.com/2009/11/27/really-peter-orszag-your-critics-have-no-ideas-for-controlling-cost/

On balance, the bills ’strengths?’:
-mandated (and therefore millions of new private insurance customers)buy-ins;
-no anti-trust buster amendment to combat standing monopolies;
-backdoor WH- (that Senator Carper was smack in the middle of) deals to prevent any price negotiation with big pharma

and (throw a few in for the GOP)
-no tort caps or
-purchase across state lines provisions.

The Senate’s progressives will try to reinvent the Senate Finance bill to create something worth voting for or they will withhold their vote.

Winning these day is having resources for negative advertising.

EXPLOITATION and threats…there is a big money war where the special interests tell Rahm Emanuel that they’ll spend 100 million in advertisement unless they get their way.

In the end they’ll do that anyway.

Even though the CBO had graded the Senate bill as fair, it cautions that no one can predict costs containment and that they do expect that costs will rise.

The best bet against costs is the public option where there is no fat profits going to stockholders or executive bonuses and no money for political lobbyists or for combative advertisement.

Carper sits squarely on the wrong side of this mess. His game is the game of lobby and influence. How does a man with kids in Ivy League schools and a career public pay check sock away three million in personal wealth? Just wondering.

But the thing is, I know that people who were not in the meetings *I* was in might see some of my work’s outcome as equally bizarre. I was a gay rights activist when Clinton decided to “pay back gay support” by starting that DADT business. I was totally WTF????????? Could you THINK of an initiative more likely to derail your presidency, sir? Suddenly we’re in the “buggery in uniform fest.” I’d have gone for more money for public health, and the Shepard act, myself, sir.

But I wasn’t there. I used to argue with WIC about the cereals covered by their program. I was right about those, too. But they’re handing out SOME cereal, which is better than nothing. I don’t know that what we’ll wind up with is better than nothing and the pissing contest aspect just makes me want to snatch away their lollipops, but I’m trying to see what comes of it.

If this bill were the result of true compromise, I’d be all for it. But it’s not. The opponents aren’t trying to create a better bill — they’re fighting to make us accept a fatally flawed bill. When it fails to better the situation, those same opponents will claim government can’t do anything right.

http://www.mydd.com/story/2009/11/27/195937/93#commenttop

I worry that what we pass in #hcr will be worse than what we have, hard as that is for me to imagine. I worry that we don’t pass anything, and incumbents of both parties will be tossed out for the hard right AND left, and things get even nastier and more blocked up. But I don’t envy anyone in Congress right now. Darn few of them have magic wands either, and I’ll bet I’m not the only one losing sleep about this.

And, as a consequence, the resulting health care “reform” will be a horrible, expensive botch. Better no bill, frankly, than a 2,000-page gift to the insurance industry.

I don’t really care about whether Democrats get elected or not, particularly if they’re the sort of Democrats who, in the pinch, tend to vote like Republicans. You seem to have bought into the inside-the-beltway mentality that it’s more important to pass something than to pass something that will work.

The reason Democrats get their asses handed to them routinely is their quivering fear of getting their asses handed to them. They try to protect themselves by caving in routinely, and the result is that nobody respects them — even those of us who routinely vote for them.

No matter what happens, TC will ride this issue out. He played it well, hate to say.