This Is Gonna Hurt…

Filed in National by on December 15, 2009

I’ve been wanting to use this classic post (I Hate Your Politics) for years, but never really had the opportunity.  Well… I do now.  And what I’m writing here isn’t directed at any individual politician – it’s directed at us.  I’m highlighting the section on liberals, but you should really read the whole thing, because he nails conservatives and libertarians perfectly.

So, let’s take a look, shall we…

Liberals: The stupidest and weakest members of the political triumvirate, they allowed conservatives to turn their name into a slur against them, exposing them as the political equivalent of the kid who lets the school bully pummel him with his own fists (Stop hitting yourself. Stop hitting yourself. Stop hitting yourself). Liberals champion the poor and the weak but do it in such condescendingly bureaucratic ways that the po’ illedumacated Cleti would rather eat their own shotguns than associate with the likes of them. Famously humorless and dour, probably because for a really good liberal, everything is political, and you just can’t joke about things like that.

Defensive and peevish even when they’re right. Under the impression that people in politics should play fair, which is probably why they get screwed as often as they do (nb: 2000 Presidential election). Feel guilty about the freedoms their political positions allow them, which is frankly idiotic. Liberals are politically able to have all sorts of freaky mammal sex but typically don’t; good liberal foreplay is a permission slip and three layers of impermeable barriers. The only vaguely liberal person we know of who seemed to enjoy sex in the last 30 years is Clinton, and look what he got out of it.

Fractious and have no sense of loyalty; will publicly tear out the intestines of those closest to them at the most politically inopportune times. The attention spans of poultry; easily distracted from large, useful goals by pointless minutiae. Not only can’t see the forest for the trees, can’t see the trees for the pine needles. Deserve every bad thing that happens to them because they just can’t get their act together. Too bad those they presume to stand for get royally screwed as well

Sound familiar?  And, yes, I wince when I read this, but he has a point.  Actually, he has several points.  Liberals/Progressives don’t lose because of their ideas.  We lose because we throw in the towel at the first loss.  We start out strong, but can’t go the distance.  It’s not that we don’t have the will… we don’t have the stamina.  And we take every political defeat personally.  Which is naive and foolish and exactly the formula for getting nothing done.  It also is a great way to absolve ourselves of any responsibility.  Health Care takes a massive hit?  Well, let’s not keep fighting.  Let’s just turn our backs on everything we’ve been fighting for, opine that all politicians are the same (Really? Really?) and walk away with our fantasy of next time.  Talk about a vicious cycle.

Actually, it’s a losing cycle, but we do excel at the purity purge.  Maybe Conservatives have taken a page out of our playbook?

I also know we don’t behave this way in our personal life.  I know that if our kid doesn’t get a good grade in math we don’t say “Forget about math, just walk away, it’s all rigged.  You failed, so it’s over”  We tell them to keep trying.  We also don’t demand that our loved ones agree with us 100% of the time.

So this defeatist attitude when it comes to Health Care is really p*ssing me off.  Seriously, that’s it?  You’re done?  Obama and the Democrats suck, and what’s the point?  Not exactly the type of person I’d want next to me in a foxhole.

I want Health Care Reform today as much as I wanted it a year ago.  I plan to fight for what I want, and keep on fighting.  I am signing onto the long haul and accept that there will be setbacks.  What I refuse to do is go down the familiar path of all or nothing.  Been there, done that.  It hasn’t gotten us anywhere.  In the nineties we lost the health care battle and walked away.  We can’t afford to do that again.  So instead of looking at this latest battle as a defeat, I’ll be looking for what I can take from it and build on.  And it isn’t as if insurance companies are going to get their act together and things are going to be honky-dory from now on.

There are many battles ahead.  The question is: do we have the stamina to fight them?  Or, is it just easier to wash our hands of all of it and remain pure-ly ineffective?

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A stay-at-home mom with an obsession for National politics.

Comments (196)

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  1. anonone says:

    Nobody that I am reading is saying “stop fighting.” We are saying that this bill as it stands now should be defeated because it does more harm than good.

    The battle for liberals and progressives now is to kill the Senate/Obomba version and then we need to continue to demand health care reform that is, you know, actually reform, not just a profit guarantee for insurance companies as this one is.

    George Orwell would be proud of anyone who actually thinks that the Senate bill is really “health care reform.”

  2. Rebecca says:

    Brilliant Pandora! I wanna play on your team.

  3. pandora says:

    I’m playing to win, Rebecca – as are you! I just refuse to sit by as we tear each other’s throats out… again. We need to focus and keep pushing forward. And this doesn’t only apply to health care. We have a lot on the table, and if we fracture, then we stagnate and end up with nothing! That’s the danger, and while I’m so very disappointed in this health care bill, there is something to build on here.

  4. cassandra_m says:

    That I Hate Your Politics post may be my favorite ever on the internets.

    Progressives never seem to get past our really great ideas to actually study history or process. None of the great progressive or liberal victories happened overnight — all of them took time to get to and they took time to fine tune once won. Some of them we are still fine tuning. We would be in the business of passing what we can, and turning back to fix what got passed.

    Social Security as it exists today is far different than what FDR got through Congress. But I have no doubt that he’d be pretty proud of where it got to.

  5. cassandra_m says:

    Senate bill is really “health care reform.”

    Technically, this effort has not been health care reform since about mid-summer. Even the House bill reforms little about health care, focusing pretty much on insurance and who is covered and how it works.

    But if you are someone without insurance now who will be able to get it under either bill, it sure does look like reform.

  6. anonone says:

    “it sure does look like reform”

    Maybe not, if you’re about to have your pocket picked by the government to line pockets of insurance companies or lose your job because your employer can’t afford the premiums.

  7. cassandra_m says:

    That wasn’t even coherent, A1.

    People without insurance are looking to get it. That is the first priority. It is a necessary evil, which is why I suspect that your purity does not extend refusing add to the insurance companies’ profits to decision-making you make for you and your family about insurance.

  8. This is painful, I agree.

    I never thought I’d have to throw myself into the pragmatist category, but I guess that’s where I am. It doesn’t mean I don’t believe in progressive ideals but I also believe in getting things done. I don’t want us to turn into the party of no like Republicans. We have good ideas and I want us to sell them to people. Giving up at the first setback is not my idea of selling your ideas. I guess I think politics is more than a debating club. It involves the dirty work. If we just sit back and do nothing then we deserve the bad government we’ll get in return.

  9. If anyone is watching CSPAN, Carper is speaking now.

  10. Mark H says:

    And while you’re at Scalzi’s website, check out his books. He is an excellent writer. I’ve read all of his Old Man War series and they are all good reads.

  11. anonone says:

    “People without insurance are looking to get it. That is the first priority.”

    I think food and shelter are probably higher priorities for most people. Under this bill, the government will force people to pay for private insurance under penalty of law if they don’t pay. So, it no longer becomes a choice. You either line the pockets of the insurance companies or you get fined by the government. Oh, and the insurance companies can charge whatever they want.


    Just because it is called “”Health Care Reform” doesn’t mean that it is. And this isn’t.

  12. cassandra_m says:

    Well I’ve already pointed out that this hasn’t been health care reform for many months now. It is a testament to your quest for ponies that you’ve just noticed.

    Lots of us pay for food, shelter and out medical insurance bills. Lots more of us would if they had access to reasonably priced insurance. This bill gets more people access to reasonably priced insurance.

    One more time — why should we prioritize hitting the pockets of insurance companies over expanding the availability of insurance to more people? How is it that it is more important to kick insurance companies in the butt than see that more people are covered?

  13. pandora says:

    I completely understand being miserable about this bill. What I don’t understand is the way people are ready to throw all things Obama/Dem out the window. I’m beginning to feel we’ve entered “good and evil” and “you’re either with us, or against us” territory.

    One of the things I like about Dems is that they don’t walk in lockstep… it’s also one of the things I hate.

    What’s missing from this discussion, imo, is balance. And if you’re really ready to throw Obama/Dems out the window, then I have to wonder if you (generic you) were paying attention during the campaign. He was always a centrist – especially when it came to health care. Hillary was further left, but Edwards was the only one who came close to promoting a progressive vision.

  14. anonone says:

    The House bill has a public option, or didn’t you notice?

    It isn’t a question of “hitting the pockets of insurance companies over expanding the availability of insurance to more people.” It is a question of the government forcing people to pay profits to health insurance companies with no cost controls or a non-profit option. That just steals money from taxpayers and/or robs the government of funds that could be used for other desperately needed human services, like actual healthcare.

    Why you can’t see that is wrong and immoral is truly beyond me.

  15. a.price says:

    im gonna get into dangerous territory here, but i think SOME THINGS are so important that they require a lockstep attitude. Heath care is too important for compromise, because a lot of people have interests other than the health of the American people on the table, and THOSE people shouldn’t get a voice. Im by no means ready to throw Obama out the window, but i sure would like him to get out of the special interest bubble. If he has people advising him who advocate for the big health racket, those people need to be.. dare i sat it.. purged.

  16. a.price says:

    agreed anonone. It is a question of right vs wrong. more profits for Aetna…. wrong. there should be no compromise.
    I remember one campaign promise made IN WILMINGTON in feb of 08. Obama said that once he was president and they were working on health care, he would make lobbyists from the health insurance scam spew their poison on c-span. the american people would get to see these bastards actually buying our politicians. what happened to that? i want to see the argument they made to carper to get him to sell us out…. I will. in the form of campaign ads.

  17. anonone says:

    If we had a President who would fight as hard for a public option and real healthcare reform as Bush did for his war in Iraq, we’d have it.

  18. donviti says:

    completely understand being miserable about this bill. What I don’t understand is the way people are ready to throw all things Obama/Dem out the window. I’m beginning to feel we’ve entered “good and evil” and “you’re either with us, or against us” territory.

    People are tired of the system Pandora. What little hope we had that we the little folk were going to have an actual seat at the table is gone. We just saw in the first year who controls what. There’s a reason why congress has shitty approval ratings and people view them as trustworthy as car dealers. dow at 10k, u/e at 10.5%. 120,000,000,000 paid out in bonus, with 3rd quarter growth at 80,000,000,00. Does that register with anyone?

    Sure, tell me to stfu and it will be all better I just have to be patient.

    I for one hate the entire system and I’m not going to allow people in the middle to call semi-intelligent or a cry baby. The people that profess they are happy with this incremental change bullshit are no better than the people that just saw the past 8 years as good ones. they are just the same as the Bush supporters were. Happy with what is given because they will take it for now, with the promise they get real change tomorrow. How often do you dopes fall for that trick?

    Our government serves the interests of the wealthy first, corporations second and the rest of us schmucks a very distant third.

    We are dismayed because there is not a 2 party system, there is 2 tiered justice. It isn’t D or R, it’s rich v. poor. And the poor are losing because people like some on this site try to call out the people that want real change as whiners and dopes.

    Who is the dope that is fine with the latest health care bill? Who is the dope that is fine with an increase in war to establish peace? So while we may appear to have given up, it’s really the people in the middle settling because they are fine with their HDTV, their cell phone and the promise that it will be awwwww betta in a few more years.

    Whatever, their all fucking money grubbing greedy crooks out for their own interests.

  19. Progressive Mom says:

    I’m sorry to say this but IMHO this is not health reform, not health care reform, and not insurance reform.

    What the Senate bill reforms is the spending patterns of millions of Americans who will be forced to pay for insurance that does not have to cover all their illnesses, does not have to cover the full cost of their illnesses, and — by the way — does not have to stay in a geographic market it finds too expensive to cover.

    I hope a few of us have Blue Cross and United in your retirement portfolios. It might soften the blow.

  20. pandora says:

    It is the system, DV, but did you really believe we could change the system in a year? This is my concern: I’m finding the timeline unrealistic.

  21. donviti says:

    It’s the system we have allowed. I mean really take a look at the dynamic happening.

    Liberals are screaming like crazy and what happens? They get fucking shouted down by who? The people in the middle for god sakes. In the first YEAR. Hello?

    Does anyone know how long it has taken the crazies on the Right to get shouted down by the moderates in their party?

    For the past 8 years we blamed bush for everything. Then yesterday Cassandra is blaming congress and not Obama. I mean this is all part of the problem. We get told to STFU and take it. While the fat cats sit at the top and laugh.

    What could have been changed in a year? Really?

    didn’t we just have the worst banking crisis ever? Care to tell me what laws have been put in place?

    feel free to reference the credit card “laws” put in place.

    How about telling Astra Zeneca and the rest of them that we are going to negotiate prices? It could happen in one swoop of the pen. Easily. But it won’t because of the “system” we allow to happen.

    DADT, done in 30 seconds.

    Yes, it’s realistic if we wanted it to be. Instead everything people hated 8 years past is suddenly ok and we just have to be patient.

  22. anonone says:

    “I’m finding the timeline unrealistic.”

    To DV’s point, that is what they want you to believe, i.e. that YOU”RE not realistic.

    The only reason you’re not realistic is because you can’t afford to buy LIEberman, Carper, or Obomba and the “too big to fail” corporations can.

    DV is exactly right: “It isn’t D or R, it’s rich v. poor.”

  23. PBaumbach says:

    lots of very deeply felt frustration over the current health insurance reform bills in Congress. lots of very deeply felt frustration over how Obama and Congress have approached this.

    wonderful. do we all feel better?

    where is the list of concrete steps which would reliably bring us to an outcome that you would find acceptable? these steps would have to get 60 votes (including of the ConservaDems in the Senate, and perhaps Lieberman), and would have a likelihood of passing public muster, despite a very well-funded advertising blitz by the industries that you demonize, applied to an under-informed and largely gullible public

    without that, it sure looks like merely pages of whining

  24. PBaumbach says:

    legislation that forbids insurance companies from denying you coverage based on pre-existing conditions, and forbids insurance companies from dumping you for making a claim is health insurance reform in my book.

  25. anonone says:

    They don’t have to deny you coverage, they can just make the coverage unaffordable for you.

  26. a.price says:

    then you get a fine and they get higher bonuses. no change.

  27. anonone says:

    no hope.

  28. PBaumbach says:

    OK, I get it, the world sucks.

    Now what?

  29. a.price says:

    not on health care. The economy does seem to be turning around, albeit slow. I still feel the Afghan strategy is the right move. I jsut need to focus my attentions on getting a job, getting health care. taking care of myself….. the american way.

  30. cassandra_m says:

    where is the list of concrete steps which would reliably bring us to an outcome that you would find acceptable? these steps would have to get 60 votes (including of the ConservaDems in the Senate, and perhaps Lieberman), and would have a likelihood of passing public muster, despite a very well-funded advertising blitz by the industries that you demonize, applied to an under-informed and largely gullible public

    This is really important.

    And I’ve asked for this repeatedly.

    Without a step by step plan to 60 votes, these whingers have absolutely bupkis.

    Which is apparently what they want for the people who are currently uninsured.

    So get your plan up fellas. Concrete steps.

    Otherwise run off and look for your ponies.

  31. myvoteisfordv says:

    I’m not a flaming liberal/socialist but if I have to make a choice between pandora’s view and donviti’s then I go with donviti. It is really difficult to believe that anything is better than nothing. The insurance companies get 30 million new customers, can charge them whatever they want and the taxpayers will subsidize the really poor. Isn’t that Medicaid? I don’t see what is gained that isn’t already available in state hisk risk pools – you still have to be able to pay the premium and pay the mortgage, buy food, etc.

  32. cassandra_m says:

    Here we go again. Someone else who can’t be bothered to even know what is in the bill.

  33. myvoteisfordv says:

    cannsandra – why do we need a plan for 60 votes? Last time I checked it took 51 votes to pass something. I say, make the GOPS get up and really filabuster 24×7. We haven’t had a real one snce the civil rights days and maybe letting the public see one in action would be what it takes – like closing down the government….

  34. cassandra_m says:

    Here we go again. Someone else who isn’t coming to grips with how the Senate works.

  35. myvoteisfordv says:

    cassandra – how do you know what’s in the bill? From what I’ve heard on the floor watching cspan, no one in the Senate knows.

  36. cassandra_m says:

    Hr 3590 is the bill’s number. Google that and multiple pdfs come up with the entire bill. There are lots of good summaries of this too — a notable one is from mcjoan over at the DailyKos. You can google that too.

  37. anonone says:

    Hey Cassandra,

    What’s wrong with actually making them filibuster? Let the repubs and Lieberman go at it. You’re quick to ridicule.

    And I’ll repeat – if Obomba had lobbied personally and hard for the public option and played some hardball with his political capital, it would be in the bill.

    No one here can say what those “concrete steps” are; that doesn’t mean it couldn’t be done.

  38. a.price says:

    here here. let them filibuster. make sure everyone knows they are delaying health care for all on behalf of the greedy bastards who put us in this situation. Let them make fools of themselves reading the phonebook…. who knows maybe they will read the names of uninsured people.
    I also agree that Obama should have advocated a lot more for the public option. We elected HIS AGENDA. why wasn’t he supporting it?

  39. So far the only plan I’ve seen people offer is have Obama work harder. I just don’t see what leverage Obama or anyone has over Lieberman or Nelson. Lieberman knows he’s toast in 2012. So they take away his chairmanship – then what? Lieberman joins the Republicans. You just can’t negotiate with Lieberman who isn’t negotiating in good faith. How was Obama supposed to fix this? Any changes in the rules have to come from the Senate itself. Again, Obama’s not a senator. Obama also has other legislation he wants to get through Congress, like financial reform. He’ll still need 60 votes. If he burns his bridges with Lieberman then he’s dealing with Snowe or Collins. That’s it. That’s what he has.

    I’m not going to argue that it doesn’t suck because it does. Majorly. But I wasnt something to happen. If progressives disengage then who is arguing for progressive policies? No one!

  40. I definitely agree – change the filibuster. Harkin is sponsoring a bill the get rid of it. Ironically it needs 60 votes to overcome a filibuster.

  41. pandora says:

    I don’t really have an answer for what I’m about to ask… Let’s say we let them filibuster, then what? Let’s say we banish Lieberman, then what? Let’s say we scrap the bill, and… then what?

    Can you tell I’m having a problem with the and “then whats?” I’m just not sure where these actions lead, although my guess is that they’ll lead to the status quo.

  42. a.price says:

    The Right put together a pretty good PR campaign. I hear Obama mention a couple times on speeches only shown on MSNBC to contact senators and lawmakers on behalf of the public option. Who cares if they are all friends? politicians’ responsibility is to us and if they have to be made uncomfortable to remember that, so be it. Obama should have thrown all the conservadems right under the bus where they belong.

  43. cassandra_m says:

    No one here can say what those “concrete steps”

    In which case you are here jut shaking your fist at the moon. If you don’t have any idea how to get to 60 votes for whatever you want 60 votes for then you can do all of the yelling you want but that is all there is.

    I don’t care about a real filibuster. You can make them do it, but that doesn’t make much difference and is just as hard on the Dems who have to maintain a presence in the chamber while the filibuster goes on. Its dramatic, but I don’t sense that it would be useful.

  44. pandora says:

    Obama should have thrown all the conservadems right under the bus where they belong.

    And then what, a.?

  45. cassandra_m says:

    As much as I’d like to vaporize Lieberman, he is (currently) on board for stuff like cap and trade — although I think he is in it to give stuff away to polluters.

  46. myvoteisfordv says:

    “and then what?”

    I believe that a large number of folks that voted for Obama actually believed him when he talked about CHANGE and “Yes We Can”.

    When they find out (and may already have) that was a myth – then what?

  47. a.price says:

    have to maintain a presence. Gosh, i want to be a senator someday. they always seem to have a recess or vacation just days away… some don’t always show up to vote, most of the time they spend at work, they are working on campaigning, and they can pretend to care about the masses while accepting hundreds of thousands from the people they are supposed to be protecting the American people from. sounds like a great job. If nothing else this whole process has reaffirmed for me that the only difference between dems and repukes is that the Dems are more closeted about their love for big business.

  48. Really a must read by Steve Benen. He puts the fight down to wonks vs. activists but the real question is whether the bill is better or worse than the status quo.

  49. myvoteisfordv says:

    How do we know what Joe Lieberman is on board for? He may just be spouting the party line from the 2000 campaign and not really be for it.

  50. Notice how Obama said “Yes We Can.” Emphasis on We. He can’t do it alone – he needs us to put pressure on our representatives. I feel too many lefties sat back and thought o.k. Obama’s handling this I’m tired. Well, it doesn’t work that way. If you want change you have to fight for it. Change is much harder to bring about than the status quo. That’s what we have learned. My question is – what do you do about it? Do you just become an armchair coach? Do you fight more? Do you pretend that having John McCain as president wouldn’t be any different?

  51. myvoteisfordv says:

    Anyone want to venture a guess on where Joe gets his lobbying job after he loses his re-relection bid in 2012?

  52. anonone says:

    Apparently, no we can’t. And quite a few people here are happy with that.

  53. pandora says:

    That’s hardly fair, A1. No one here is “happy.” But I’m not ready to slit my wrists either. What I find fairly amazing is how shocked people are by Obama’s positions. He was always a centrist, and while I haven’t agreed with all his decisions I haven’t been shocked.

  54. myvoteisfordv says:

    Give me 3 things that would be different if McCain was President and you can’t use the White House dog, the White House vegetable garden or that the First Lady would be a blond instead of a brunette.

  55. pandora says:

    1.) Health Care wouldn’t even be discussed.
    2.) There would have been no stimulus
    3.) And, we’d be gearing up to invade Iran

  56. anonone says:

    1) V.P. Palin, not Biden
    2) We’d be at war or occupying Iran
    3) Unemployment would be +12%

  57. cassandra_m says:

    Pandora, A1 is not about fair. if he was, if would have been more responsive to the multiple questions posed to him. If he actually had a solution to get to 60 votes there may be something to get behind and actually change. But hiding behind some vague “other people” should be working harder and a persistent need to attribute to people words and feelings that he can argue against in an effort to maintain his superiority over the rest of us.

    A1 isn’t much different from the keyboard kommandos we made fun of cheering for Iraq but dead set against joining up. Delighted to scream at other people to get to work, but with no idea how to get that work done.

  58. anonone says:

    No one here is “happy.”

    OK, you’re right.

  59. myvoteisfordv says:

    1) Are you serious? and if you are, discussion and $1.50 buys a cup of coffee
    2) I’m not sure that is true either but things haven’t been stimulating to a lot of unemployed folks
    3) How do you know we aren’t doing that now?

    We would still have the same #s in the Congress – really think that McCain would have somehow changed what has been “accomplished”?

  60. pandora says:

    You’re dancing, myvoteisfordv, and not dancing particularly well.

  61. myvoteisfordv says:

    We actually may have accomplished a whole lot more while the media and the country spent its time talking and watching about Sarah Palin being Sarah Palin.

  62. myvoteisfordv says:

    LOL, I was thinking the same about your dance steps….

  63. anonone says:

    cassandra, I answered your questions and your “concrete steps to 60 votes” question is a load of rhetorical crap. Obomba didn’t even try. He went AWOL over the summer and let the repubs dominate the debate. He didn’t fight for the public option at all. So don’t come asking me how to get to the 60 votes when your dear leader did squat.

    What you should be asking is why Obomba do nothing to fight for it. He was all about capitulation, and once the insurance companies and Lieberman saw what a weakling he was, they just stole his lunch money.

    Maybe if you could actually show how your dear leader pulled out all the stops to fight for the public option and then lost, you’d have a case. But you can’t because he didn’t – and you got nothing.

  64. cassandra_m says:

    question is a load of rhetorical crap

    60 votes get you WIN.

    Amazing that you would find that a load of crap.

  65. anonone says:

    Now Howard Dean agrees with me:

    “This is essentially the collapse of health care reform in the United States Senate. Honestly the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill.”

  66. anonone says:

    No, I find that you asking ME that question is a load of rhetorical crap. You should be asking Obomba that question.

  67. cassandra_m says:

    And as much as I love Howard he is quite wrong here.

    There is NO WAY the House and Senate go backwards on this thing. NO WAY. If something does not get done now, nothing will for a ververyvery long time.

  68. cassandra_m says:

    Why would I ask Obama that question? Neither he or Reid can get there. You are the one insisting that it can be done. Either you know how to do it or you are full of shit.

    I know which one I’m voting for.

  69. delacrat says:

    Comment by pandora on 15 December 2009 at 2:54 pm:

    Under McCain………………………………………….Under Obomba
    1.) Health Care wouldn’t even be discussed…..1.) Health Care gets “discussed” WOW !
    2.) There would have been no stimulus………..2.) We have a “stimulus” (bankster bailout)
    3.) And, we’d be gearing up to invade Iran…….3.) We’re gearing up to attack Pakistan.

  70. anonone says:

    Cassandra, all you’re trying to do insist that I should be able to explain how to get the toothpaste back in the tube. The point is that Obomba didn’t do ANYTHING when he had the chance, and now it is too late for this bill. If Obomba had shown some leadership and fight for a decent healthcare bill back in the late spring and summer, we might not be here now, but he didn’t. And you won’t admit that.

    But you’re all about excuses and distractions, aren’t you? You’re all about name-calling and rhetorical games, aren’t you?

    You’re defending Obomba and HCR in the same way that the repubs defended Bush and WMD.

  71. myvoteisfordv says:

    Can someone explain to me what is bad about reimportation of prescription drugs and why we don’t allow it?

  72. anonone says:

    1) The official excuse is that counterfeit drugs will slip in since we can’t control the supply chain as well.

    2) The real reason is that countries like Canada have actually negotiated cheaper prices and the drug companies don’t want to sell drugs at those prices in the U.S., which has made negotiating for cheaper drug prices by the Federal government (the biggest purchaser) illegal.

  73. myvoteisfordv says:


    Why would Democrats be for that?

    or is this another of those “then what” issues?

  74. myvoteisfordv says:

    P.S. My junk email folder already receives 100 offers a day for fake prescription drugs so the current laws don’t seem to be stopping that business.

  75. cassandra_m says:

    This is when we know you no longer have anywhere left to defend the indefensible, A1 — the excuses and distractions have all been yours. Multiple people have asked you very pointed questions largely designed to get to either 1) why we should wait for the perfect at the expense of a good start or 2) how you can get to your perfect world via 60 votes.

    It is massively dishonest to just say that one person didn’t do enough, when it is others who keep derailing the process. If you know that things would be different — that implies that you know how to get it done. It is not unfair to insist that you detail how you get to 60, since you think you have some special knowledge that Obama could do it. You were the one talking about killing the bill and reorganizing to fight for something better. That is CLEARLY a delusion at this point. If neither chamber of this Congress could pass something remotely progressive (and I note that you’ve convinced yourself that the House bill does that) you WILL NOT GET A BETTER RESULT from wither this Congress or a subsequent one. Not unless you are willing to get alot more members who think like you do. And you will work harder at indulging your self-superiority than at getting better Democrats anywhere.

    It is also massively dishonest to just sit back with your insurance coverage and your ability to get medical care and condemn lots of other folks to no possibility at either because you did not get the bill you want. This isn’t much different from the repub I’ve got mine, you can go to hell stance. Except this time you are trying to pretend that there is something principled about letting these people languish. That is just not right. More people should get this access to insurance that they can afford now — and we work on fixing it all the minute it gets passed.

    Letting more people get sick and die because you need moral superiority is completely immoral and completely delusional.

  76. myvoteisfordv says:

    Up to this point,my observation was that “discussions” with liberals compared to conservatives was that conservatives were meaner, made it personal and were apocalyptic.

    Check that.

    There really isn’t that much difference.

  77. anonone says:

    President Obama Tells Bald-Faced Lie About Health Care Reform Cost Control

    Keep defending Obomba, cassandra_m. You’re beginning to sound like republican david defending George Bush.

    You asked:

    “1) why we should wait for the perfect at the expense of a good start”

    We shouldn’t, but this isn’t a good start. It is a bad and disastrous bill.

    “2) how you can get to your perfect world via 60 votes”

    Elect a new President willing to actually fight for it, primary those who are against it, and get a new Senate majority leader.

    I’m with Howard Dean on this. And you have yet to tell me how Obomba has been fighting for a decent HCR bill because I have shown you undeniably that he hasn’t.

    You’re being fooled about this bill, cassandra, in the same way that Bush fooled the country about WMD. This bill is mostly for the benefit of insurance companies, and it is a government mandate for citizens to pay for the profits of private companies or else face huge fines. That is unprecedented in our history. It does nothing to cut costs or limit premiums. And your comparison of mandatory auto insurance to mandatory health insurance is beyond belief disingenuous and callous. Health insurance is a human right. Driving or owning a car is not.

    Calling me “massively dishonest” for speaking the truth about this bill is absurd, and then attacking me personally for having health insurance as somehow disqualifying me from objecting to this bill is beyond ridiculous.

    If not wanting to see the same people who can’t afford health insurance today lining up to pay massive fines to the government or going to jail because they can’t afford to pay for the insurance companies’ profits is the morally superior position, then I’ll take it.

  78. cassandra_m says:

    There are cost control aspects to this bill — none of them go far enough but it is a start. And one of the ways costs start to get under control? Covering more people. Because as long as a portion of my costs include the cost of the uninsured, you never start reducing anyones costs.

    I’m not fooled by anything about this bill. As you well know. I’ve spent more time with pretty much every version of these bills than you’d even think of doing. It is also why I’m clear that the House Public Option isn’t much of a cost control measure either.

    The people being fooled are the people who just want something called a Public Option without ever taking the time to see how it works. And the Reid Public Option was completely worthless and the House one doesn’t reduce much in terms of costs. As the CBO scoring document would have told you. You are interested in being able to hoist a Public Option flag over the ramparts. I am interested in getting people more health care coverage.

    So you go right over to FDL and keep cheerleading (because that would be all you are doing) for your symbol. Your symbol doesn’t improve health are options or outcomes for very many Americans. Certainly not in any form that it exists in any bill now.

    You are massively dishonest — and until you can detail how to get to where you want to get to or provide an explanation as to why people should pass up a chance at health insurance — insurance that you already have — because you object to the business practices of insurance companies you will remain an utterly immoral bastard.

  79. Von Cracker says:

    The People get the democracy they deserve.

    All those CT voters – when Blue Cross rations (read: caps your benefits) and your spouse, friend, daddy or granny dies a premature death, please thank Joe!

    Better yet, make a donation to CT for Lieberman – just to show your appreciation!

  80. Von Cracker says:

    Should we suspend all economic aid to Israel, Joe? They have socialized medicine over there you know?

    so glad he’s old and on the downside of public life….

  81. anonone says:

    “you will remain an utterly immoral bastard”

    You know that you’ve lost this argument now, don’t you?

  82. cassandra_m says:

    No, actually — because it is pretty clear to me that someone who would privileged an ineffective public option(and all of the other crap that you’ve prioritized) over getting real people insurance coverage is immoral. By definition.

    Which is a thing you would understand if you were watching a repub offer up your rationalizations and handwaving.

  83. anonone says:

    Ah, cassandra_m, the delicious irony to all this is that if this identical bill was from the repubs, you’d be smart enough to be against it, too.

    I guess that you must think Howard Dean, M.D. is an “utterly immoral bastard,” too. How sad.

  84. PBaumbach says:

    cassandra–you get serious points for putting up with the crap today

    the bill in the senate is not crap, it is worse than other versions have been. as I’ve already said, forbidding insurance companies to not offer coverage to those with pre-existing, and to not drop those who use their policies IS A GOOD THING. If you don’t think so, you are delusional.

    Yes, we’d love a LOT more. But this may be as much as our current crappy Congress seems to be able to do.

    For those who think that Obama should have worked harder to get the bill done, please open your history book to how Bill (and Hillary) Clinton fared with that strategy, ON THIS SAME MATTER.

    We have separation of powers. Deal with it.

  85. pandora says:

    I’m leaning towards Yglesias, Drumm and Klein (links here:

    “Probably not that many people feel this way this morning, but I think part of what we’re seeing at the moment is that the organizing campaign around the public option has been an enormous success that did a lot to improve health care policy. I think that the deal emerging in the Senate leaves us with a package that’s not just “worth passing” but actually as Kevin Drum says a really good bill. If Barack Obama signs it into law, he’ll go down as the president with the most progressive legislative accomplishments since Lyndon Johnson. You’ll say that the American welfare state was inaugurated by FDR, substantially expanded by Johnson, and given its final shape by Obama.”

    To me (one who has excellent, top of the line insurance – zero deductible, no referrals, no co-pays) there are real people behind this debate – And I’m extremely fortunate not to be one of them.

    Yes, I think this bill could be way better. Yes, I think this bill gives way too much to the insurance industry. And, yes, there’s a part of me that says, “screw it, I want better.” But I do have the luxury of that position.

  86. meatball says:

    The bill can still be vetoed, of course.

  87. cassandra_m says:

    Ah, cassandra_m, the delicious irony to all this is that if this identical bill was from the repubs, you’d be smart enough to be against it, too.

    No actually — I would still be very glad that there are alot of people who would get better access to health insurance and health care. And I would be bashing them for not going far enough. But there is no possibility that I would be arguing for nothing just because my demands were not met. It is in the latter that you will find your immorality.

    And if you’d like to know what I think about Howard Dean — you can ask me that. Don’t just make up more shit so you can once again pretend to be ohsosuperior to the rest of us. You could take some of that energy you spend in working at all of the superiority in figuring out the rules for filibusters, the rules for reconciliation (this is crucial) or even wrapping your mind around a few OMB reports. It’s wonky, but there is a mountain of data about all of these bills and programs that you have no idea about.

  88. anonone says:

    Remove mandate, or kill this bill

    An answer to Klein. Of particular note:

    “Provisions prohibiting rescissions are fine and dandy, and fairly non-controversial, but they are toothless. The legislation allows rescissions based on “fraud” and “willful misrepresentation”. I’m still not sure what that means, but if the insurance company doesn’t want to pay for your expensive care, seems they can assert those clauses and refuse to pay. Then what? You have to fight for coverage, get lawyers, hit the courts, hope you survive long enough to resolve the issue. Looks a lot like the status quo, doesn’t it? Indeed, insurance companies already cite fraud or misrepresentation as the excuses for rescissions.”



    An utterly immoral bastard

  89. anonone says:

    Oh, cassandra_m, I said that I was guessing.

    Since I am an “utterly immoral bastard” for saying “kill this bill” while also (gasp!) having health insurance and since Howard Dean says the same thing, well…it seemed like a reasonable guess.


    Your utterly immoral bastard

  90. Progressive Mom says:

    This process was mishandled by the White House and the (real) Democrats from the beginning. It was almost like watching the geeks in high school take over for a day, thinking that the next day they would still be in control based on their mojo.

    The White House held back, gave contradictory messages, and Obama was completely uninvolved in what was the seminal issue throughout the campaign. The crazy wing of the Republican party controlled the messages all summer.

    Then, the WH made the big pharma deal behind closed doors, and all players realized they didn’t have to take the WH seriously on anything. Including the bluedog Dems, who realized that Obama wasn’t going to have their backs if the shit hit the fan.

    I would agree, PB, that having no pre-existing clauses and no recessions (maybe) would be a good thing; except that it’s being offered to people who have NO CHOICE BUT TO PURCHASE THE LOCAL POLICY — and, believe me, in most of the US geography, there will be ONLY ONE plan to select. How long do you think it will take the insurer to cry about how it’s not making any money? How long do you think it will take the insurer to blackmail its community: give us the increases we want or we’re leaving. (Original Medicare managed care plans did this nationwide. Look it up.)

    I was more than willing to give up my personal rights about how to spend my money if the government was willing to create a level playing field for those dollars. The public option was the level playing field. Now, I turn over my rights for insurance profit.

    And before anyone gets on his/her high horse about how I have my insurance and others don’t — my 20 year old son is uninsured, uninsurable (pre-existing) and there’s nothing in this bill that guarantees that the insurers will have to offer coverage for his particular condition, which is one of the big three carve-outs. His father and I are one of his illnesses away from bankruptcy every day of our lives.

    And there’s nothing in this bill to help him. But he’ll have to pay anyway. Maybe he can get a government job. It seems to work for Liebermann.

    Cassandra, the 60 vote issue is a red herring. A filibuster on this issue could have taken the Republicans down in flames if the
    Democrats weren’t acting like sheep, Reid wasn’t such a ineffective leader (and he has been for years, we all know that), and Obama had the courage of any of his earlier spoken convictions.

    But, as Cheney famously mentioned, we’ve gone to war with the army we have.

    And they surrendered months ago.

  91. pandora says:

    Can we please STOP this. There’s a debate to be had. I don’t like the way the bill is shaping up, but I’m not ready to trash it. Why is that a “sell-out?” Why are we (liberals/progressives) dividing up on this?

    And why can’t this be a starting point? Please explain how passing this bill will be an end rather than a beginning. And, yeah, I feel guilty that I don’t really have a dog in this race, but my heart’s in the right place.

  92. anonone says:

    Stop what, pandora?

  93. pandora says:

    PM, you make very good points, and I don’t disagree. But how do we get there? This is really the point. I don’t see the scenario you, and others, put forth ever becoming a reality – as much as I wish it so. And maybe that’s the wonk in me. I agree with everyone I’ve been battling with today, but until someone shows me how we turn this vision into a reality… then we got nothing.

    And, believe me, if you can show me the way, I’ll follow.

  94. anonone says:

    Nice comment, Progressive Mom.

  95. cassandra_m says:

    Cassandra, the 60 vote issue is a red herring.

    The flip side of this is that if you had your 60 votes, no one would be going through all of this. It is a red herring if you think that passing a bill out of the Senate is not material to the process.

    How the heck can I be on a political blog with a bunch of people who don’t even grasp the basics of how your own damn government works? The President is NOT SUPPOSED TO WRITE LAWS. That is CONGRESS’ job. Does anyone at all remember how disdainful we were of the Karl Rove-run legislature? If you didn’t like it then, why they hell are you pining for it now?

    This bill is not perfect — far from it. But this bill does more than any President who ever tried to get universal health insurance ever got to. EVER. So if this goes through and the President signs it, you are no longer fighting for health care for the many. Now you are fighting for real cost controls, you are fighting for real competition, you are fighting for more choices — in short, you are building on what you get now. The fun thing is (for those of you who won’t go read up on how reconciliation works) the stuff that might get you better cost control and competition you can likely get pretty easily via reconciliation.

    And these Democrats who helped water down these bills were not sheep. They were specifically representing their preferred constituents — health insurance and health care companies.

  96. cassandra_m says:

    It does occur to me that Tom Carper must be feeling pretty chafed today. He was working overtime for “compromises” and certainly taking alot of grief from here (and other places) for doing that. Bet hw wishes today that his ace pal Lieberman had just told him he was going to pull a Lucy. Carper could have saved himself alot of grief by just embracing the public option.

  97. donviti says:

    It bothers me a little that this site is Delaware Liberal yet all I here is stuff that the middle would say and not liberal.

  98. Progressive Mom says:

    I have never gotten picky at this site — or any other — about wordsmithing, and I don’t like doing it with Cassandra, with whom I agree on many things, but….

    “The flip side of this is that if you had your 60 votes, no one would be going through all of this.”

    Duh. But the mojo didn’t last, and it was never going to. That the Dems didn’t have 60 votes and are shocked, SHOCKED I tell you!, that they don’t is right up there with : “who knew the levies would be breached….?” Again, this was botched by the geeks from the beginning, just like the Clinton effort was.

    “The President is NOT SUPPOSED TO WRITE LAWS”

    Duh. But he is supposed to work to get his legislation passed. Like Johnson, Kennedy, Reagan, Roosevelt (both of them), etc. That means he wasn’t really behind real health reform, or he’s stupid, or he’s shocked that his mojo didn’t last. Or — dare I say this about a president I’d still like to believe in — did he get so awed about being president he has momentarily forgotten to be one?

    “But this bill does more than any President who ever tried to get universal health insurance ever got to.”

    Please let that be the last time you use “universal Health insurance” and this Senate bill in the same sentence. And only one other president tried, so it’s a fairly low bar. This isn’t universal health care. This isn’t even about health care. It’s about carrying health insurance that citizens are mandated to pay for. On that scorecard, it goes pretty damned far.

    “So if this goes through and the President signs it, you are no longer fighting for health care for the many. Now you are fighting for real cost controls, you are fighting for real competition, you are fighting for more choices — in short, you are building on what you get now”

    So, if this goes through and the president signs it, you are no longer fighting for health care for the many, for people and their lives. You can appear petty and fight for more choices, for lower costs for you and your friends — in short, you have lost the high moral ground and you will sound very much like conservatives who don’t like high taxes. You won’t be talking about health care — you’ll be talking about your personal family budget.

    “The fun thing is (for those of you who won’t go read up on how reconciliation works) the stuff that might get you better cost control and competition you can likely get pretty easily via reconciliation.”

    Pretty easily? Pretty easily? Are we talking about the same reconciliation process? And “competition” is going to be created during reconciliation? How? What is reconciliation going to do about the free market system and the corporate structure that health insurance coverage requires?

    I’m not sure why all this passion is being invested to defend what is a weak-tea bill that mandates that people use their personal funds to purchase insurance whose cost can change at any time for any reason; whose limits can be structured by the insurer at any point; where insurers can, and often will, be for profit monopolies in their regions; where there is no limit on the amount of profit that can be made by the insurers on the people’s money; and where hospitals, physicians and other providers will be forced to negotiate payment in a closed, monopolistic market … where “making it up on volume” will become the rallying cry.

    I don’t have any problem with people who are willing to settle for this bill. I have serious problems with this bill. It will not solve any of the problems that were originally the reason for this bill’s existence, and it is going to create mountains of new problems.

    When you’re up to your ass in alligators, remember that it was your idea to drain the swamp.

  99. Progressive Mom says:

    Pandora — to answer your first question about why can’t we just build on this bill….

    IMO this bill is going to create so many problems for so many people, with so little payback to them in return, that I fear it is headed for an early grave. Republicans are already planning — very strategically — on how to kill it two years from now before most of the provisions kick in. Because they are being strategic, something the Democrats weren’t, and because I think this bill is going to hurt individual families as well as providers, especially in the short run, I think they have a good chance.

    To answer your second question, what do we do: I wish I had a three paragraph, internet ready answer. Because it appears that’s all many Democrats, and most of our D Senators and Congresspeople, have the time or patience for. (I’m not speaking of you personally or the people here; just the party in general)

    I believe that Obama is close to losing the bully pulpit and his ability to set the agenda — not exclusively because this bill is so bad, but because it was so badly handled. As the head of the party, his ability to control the public discussion is crucial, and he’s not using it at all. Without that, honestly, I don’t think much can be done.

    (And if you scoff, remember how quickly we stopped talking about the effects of Katrina, because it wasn’t part of the Bush Administration agenda. Yet every person with an Arab-sounding name who was arrested for littering made the front page for years, because that was the Bush agenda. They were excellent at controlling the message. We suck.)

    “If you can show me the way, I’ll follow.”

    Damned, Pandora, if that isn’t a perfect description of the many independents and Dems who followed Obama during the campaign.

    Now? I don’t see any leadership in the Senate or the WH. Pelosi has done a great job in the House, but she’s now been hung out on a branch by her own party. It’ll be interesting to see her reaction.

    Without leadership, there’s no bill that will be meaningful. And I don’t have high hopes for his one, even when it passes (and it will, and Republicans will laugh their asses off about it).

    Those alligators of mine, from the previous post, will be licking their chops.

    I’ve talked too much — thanks for listening, all.

  100. donviti says:

    I blame congress for all this, but only this congress. Before that I blame Bush and not his congress.

    It’s my logic and I will cry fowl if I want too

  101. pandora says:

    I hear you, PM, and I mostly agree. But we have to get “there.” And I don’t know how. This bill, as flawed as it is, seems like a first step – something to build on. I will lay serious money on the fact that if we scrap this bill we scrap everything. Show me how that won’t happen, and if it does happen how that’s worth it.

    And you can only issue an ultimatum if the people you’re threatening give a damn. The Dems/Obama have no influence over Lieberman and Nelson and the rest. There is no leverage I can see. Which sucks.

  102. pandora says:

    Fowl? Seriously?

    The Dems gave Bush what wanted – the same Dems we are dealing with now.

  103. A. price says:

    I think the difference in blaming Bush, then THIS congress is; bush had controll over congress. Obama doesn’t.

  104. A. price says:

    the sad irony here is that during the Bush years, we were crying for the separation of powers. Now that we are getting our wish, it is biting us in the ass….. I pose this question. What if the republicans get control of the government when the government controls health care?

  105. Progressive Mom says:

    The government isn’t in any danger of controlling health care.

    The insurers control health care. And, apparently, the government.

  106. I think it was somewhat unfair to compare Obama to Bush. Though the media ignores it, the 60-vote supermajority is something that just started in this Congress. Democrats filibustered sometimes but Republicans filibuster everything, just because they can. And they are united in saying “no” (it’s so much easier than trying to govern). Bush had Democrats who were willing to vote with Republicans (the same ones we’re talking about now).

  107. anonone says:

    Here is another “utterly immoral bastard” named Howard Dean saying “Kill the bill.”

    “Dean’s two central points: (1) Saying it’s “now or never” on health care reform presents a false dichotomy. Our health care system is in crisis, he says. We need to fix it now, it won’t be another twenty years before we get the chance if the Senate bill fails. (2) The Senate bill fails to reform the system; indeed, it expands the current system which is already failing because it is too expensive.”

  108. anonone says:

    “Obama thanked Lieberman privately for his statement issued earlier Tuesday pledging support for the bill as long as the Medicare expansion and public option were eliminated from the bill, Lieberman said.”

    Thanked him. Hear that, cassandra_m?

  109. cassandra_m says:

    That the Dems didn’t have 60 votes and are shocked, SHOCKED I tell you!,

    So you are not surprised that Lieberman pulled his Lucy act this week? Everyone else was — the focus was the others, Nelson, Lincoln, Landrieu. The anger phase of the grieving process was triggered by Lieberman. And apparently — unless Nelson decides to act up — they’ll have 60 votes. But not for the weak public plan that was in Reid’s bill.

    That means he wasn’t really behind real health reform, or he’s stupid, or he’s shocked that his mojo didn’t last.

    Or it means he was dead set against the Clinton approach. At the very beginning of this thing Obama let people know that he was willing to set out some guiding principles and let the Congress do its work. Lamenting this approach is a wee bit late. But it isn’t as though he wasn’t clear about it. And while we are on some history here, one of the biggest reasons that Dems voted against the Clinton health plan was that they had no ownership of it. Democrats — again — are not willing to be a parliamentary body. Republicans will.

    Please let that be the last time you use “universal Health insurance” and this Senate bill in the same sentence. And only one other president tried, so it’s a fairly low bar.

    Truman tried, LBJ tried, Clinton tried and Teddy Kennedy took a spin at health care a bunch of times and you should note the level of effort at each effort. Ambitions attenuate. Because everyone looks to the past to size what they can do now. But you can look at this bill as the last big piece of coverage that finally insures almost every American. If Bill Clinton had gotten just this bill back in 1993 or 4 he would be a hero today. And today you would be agitating for improvements to what Clinton had gotten and not fighting to just get your foot in the door.

    “The fun thing is (for those of you who won’t go read up on how reconciliation works) the stuff that might get you better cost control and competition you can likely get pretty easily via reconciliation.”

    I have no idea what reconciliation process you are working with, but the one I know of is designed to pass budget bills. A Public Option or changes to the subsidy scheme or Medicare buy in or expansions of the exchange as they impact government expenditures or revenues are eligible. The stuff that isn’t eligible are rules about recissions or the establishment of test programs that might show the way out of fee for service. And easily meaning that you no longer have to work for 60 votes.

    You can appear petty and fight for more choices, for lower costs for you and your friends — in short, you have lost the high moral ground and you will sound very much like conservatives who don’t like high taxes. You won’t be talking about health care — you’ll be talking about your personal family budget.

    This would be Bullshit. Apparently you don’t know that Social Security as it exists now is quite evolved from what FDR got in place. You get this working for a couple of years and you have data and experience to work with. And by then, a bunch of Congresspeople who are being assaulted with the need to make this system work better. Or perhaps this is just the signal that you want everything now, too.

    Lots of people have serious problems with this bill. And we’ll do all of this again after this bill emerges from conference because this is not its final version. But having most Americans having access to health insurance in 2014 or whenever this goes into effect is not something to be ashamed of. This can be made better and that ought to be the work. People in Massachusetts who have something similar hate the cost of their insurance but they mostly have it. So guess what people are working on.

    And this: bush had control over congress. is not true. Bush had control over *his caucus* and peeled off enough Democrats to get his agenda pushed through. And as Pandora notes these are the same Democrats whose names are mud now. The last time any Democrat had anything near the kind of singular control over their caucus that Bush had might have been LBJ and even then he couldn’t get all of them for everything they way that Bush did. You really need to come to grips with that. Democrats simply do not operate the same way that repubs do.

  110. anon says:

    . But you can look at this bill as the last big piece of coverage that finally insures almost every American.

    No. The Senate bill is not it. It is not social insurance. Imagine if we had tried to implement Social Security by requiring that workers prove they have an account with Goldman Sachs, Merrill, JP Morgan, etc.

    The Senate health care bill is like Bush’s Social Security privatization bill. At least Republicans had the sense to kill that one. Let’s hope Dems have the same smarts now.

    Handing over 30+ million new mandated customers to the mercy of a rogue insurance industry with its very own antitrust exemption, and no real competition public or otherwise – nope, that is not the last plank we have been waiting for.

    The work goes on, the cause endures, hope still lives, and the dream shall never die.

  111. Perry says:

    I agree with the realists in this thread, and Obama said it himself: Everybody cannot get what they want in this bill.

    Reconciliation will produce the final bill. We go into reconciliation with whatever it takes to produce 60 votes in the Senate, nothing less, and a House Bill that has a public option.

    It is not a sign of weakness on the Dems or on Obama that we can’t get a public option or extended Medicare out of the Senate, because the Dems cannot and do not have total control, a filibuster override capability. And we are up against lock-step wingnuts. Like it or not, that’s reality.

    So as somebody has already said, we Dems and Independents must get the most that we can in the Senate Bill, and finally the most that we can in reconciliation, and campaign on that achievement, and commit to building in the future on what we achieve now.

    What worries me is that many of the benefits from the final bill will not be felt by most people until 2013-14, thus whatever bill passes will not yet be felt in time for 2010 and 2012 elections.

    It is ironic that the big tent Dem party chaos is further handicapped versus the far right opposition wingnuts who put party loyalty at higher priority than what is good for the nation. If the Dems and Independents campaign intelligently, we could well prevail in 2010 and 2012 over the no-nothing wingnuts. Let us not panic, instead campaign and build on the foundation that we have produced.

  112. Ergonomic says:

    Wow Perry.
    Makes me feel a bit less cynical.

  113. I have no idea what reconciliation process you are working with, but the one I know of is designed to pass budget bills

    I strongly suggest that you read Jon Walker’s new post about putting this bill through reconciliation. It would appear that he knows a lot more than you about the subject.

    “First, the argument ignores that reconciliation would still protect the guts of reform. For example, half of the people who will gain insurance (roughly 15 million) will get insurance because of the expansion of Medicaid. Expanding Medicaid is completely doable with reconciliation.

    Expanding Medicaid, Medicare buy-in, the public option, closing the Medicare doughnut hole, taxes, affordability tax credits, cost control reforms for Medicare and Medicaid, and more can all be done with reconciliation. These are all the most difficult parts of reform.

    Secondly, the argument that reconciliation could strip out the important insurance regulations is very weak. Technically, provisions not related to the budget can be removed by the Byrd rule, and that includes the important new insurance regulations (ban on pre-existing conditions, community rating, lifetime limits, etc.), but there is a very important caveat: these provisions will only be removed if they fail to get 60 votes to wave the Byrd rule for those provisions.

    I dare all 40 Republicans plus one conservative Democrat to vote for a stand-alone provisions that would let insurance companies continue to exclude people for having pre-existing conditions. If they are foolish enough to vote against extremely popular insurance regulation as stand-alone provisions they will face the mother of all attacked ads in 2010.

    I suspect that there will only be a very narrow set of provisions that don’t violate the Byrd rule, and would not get 60 votes to wave the Byrd rule. It is possible the Republicans will vote “no” on everything related to reconciliation as a protest against reform. Even if the Republicans do unite to commit political suicide by voting against a wavier of the Byrd rule for the extremely popular insurance regulations, that is only a temporary set back. The insurance regulations can be added as a whole or piecemeal to some big omnibus defense bill.

  114. pandora says:

    Which brings us back to 60 votes, Nancy. Are you counting Lieberman in that 60?

  115. just talking says:

    Got to admire Bush got everything he wanted without 60 votes the dem’s can’t do it with the house senate and White House no leadership except Nancy and I sometimes wounder about how long she will hold out.

  116. cassandra_m says:

    Oh good. Someone else without a clue.

  117. anonone says:

    The ones without a clue are those that think getting 60 votes just so they can pass a bad bill is a good thing.

  118. anonone says:

    Howard Dean in WaPo this morning:

    “In Washington, when major bills near final passage, an inside-the-Beltway mentality takes hold. Any bill becomes a victory. Clear thinking is thrown out the window for political calculus. In the heat of battle, decisions are being made that set an irreversible course for how future health reform is done. The result is legislation that has been crafted to get votes, not to reform health care.”


    “I know health reform when I see it, and there isn’t much left in the Senate bill. I reluctantly conclude that, as it stands, this bill would do more harm than good to the future of America.”

    Read it all:

    But cassandra_m wants those 60 votes non matter what.

  119. pandora says:

    Again, not fair, A1. No one here is thrilled with this bill. We supported the public option and expanding Medicare. We don’t like the mandates or the penalties. Basically we all agree.

    The point of disagreement lies in what to do next – kill the bill or pass the bill. And what happens after we pick one of those options is anyone’s guess. Those for killing the bill believe that the HCR process will start anew. Those for passing the bill believe this will be our only chance at health care for a long time. Those for killing the bill believe it does more harm than good and cannot (or will not) be improved. Those for passing the bill believe there’s some good in the bill and that it can be built upon.

    Truth is… pass it or kill it, no one really knows what happens next – and that includes Howard Dean. We are rolling the dice. And no matter who wins this “debate” people’s lives are at stake.

  120. anonone says:

    pandora, it isn’t a question of being “fair” or not in this debate. It is a question of debating the merits of the particular bill under discussion. And “what happens after we pick one of those options” is NOT “anyone’s guess,” and it is naive to think that. This bill has huge financial and legal consequences to every single American that are not “anyone’s guess.” It will turn people who can’t pay their insurance premiums to private insurance companies or fines to the Feds into criminals. You think that is “rolling the dice”!!?

    Howard Dean has been fighting for HCR for more than a decade. He understands the consequences of this bill, and he has nailed exactly what is going on in D.C. right now. And you know who else understands the consequences of this bill? The insurance companies, which is why their stocks are climbing.

    Why don’t you post Dean’s article this morning and start a discussion on it?

  121. Perry says:

    If the process were to start anew, there would still not be one Repub who would vote for it, and there would still be one or two Dems who would game the system, therefore, what is the gain?

    It is too bad that we did not start with single payer, or the Swiss system, so at least we would have a CBO estimate of the cost of a decent health care bill and a better bargaining chip than we currently have.

    It is too late for that, so we must go with what we have, and let the House-Senate Resolution process make the result better, like removing the mandate, like introducing a public option. Then, if a Dem or two kill the final bill, it is on them and the Repub wingnuts, not on the majority, if it is framed properly in the 2010 campaign.

    So I am with Cassandra, get the 60 no matter what, so that we get into the resolution process to attempt to improve what we have in the Senate Bill.

    PS: Howard Dean is discounting what can be accomplished in the House-Senate resolution process. Moreover, his approach is tantamount to repeating the 1993 catastrophic failure. What progressive wants that result?

  122. anonone says:

    “So I am with Cassandra, get the 60 no matter what” – That’s sheer idiocy, Perry. Sorry.

  123. nemski says:

    A1, what powerful Democrat who was instrumental in helping Obama get elected was not made a member of the Obama Administration? I wonder who it could be? Could it be Howard Dean!?

  124. Progressive Mom says:

    I thought you were referring to David Plouffle (sp?), Nemski!

  125. just kiddin says:

    Anoone: of course it was Howard thrown under the bus by Obama at the request of Rahm Emanuel. It was Rahm who did the dirty deal with Big Pharma, it was Rahm who has been doing the talking for Obama. Obama wants a bill, he could care less whats in it. This administration is no different than any other. All of them are in cohoots with big corporations and insurance companies. Why cant we negiotiate better prices based on volume for drugs? Cuz the deal was done with big pharma in the summer.

    Get ready to pay $13,000 for a family of four. Get ready to pay a huge fine if you cant afford to buy your insurance from the greedy corrput insurance companies. Is this change you can believe in, hell no.

    Dean is right, we need to flush this bill and start over. Or go to reconcilation. This is a terrible bill, might as well have been written by the repukes. The democrats will own it when the general public figures out “how they were sold out for corporate america”.

    There is no health care reform in this bill, this is a huge giveaway to the insurance companies they now have millions more people to exploit. The few good things in the bill i.e. no able to kick you off if you have a pre existing condition, fine. However, the billions they will make off the 44 million now being delivered up on a silver plate offsets the costs of the pre existing condition.

    We must fight against this bill, we must no accept minimal changes that could easily be obtained through reconcilation. Why hasnt Obama come out and said “what he wants”. He will never do that but let the Congress and Leiberman take the heat for this horrific legislation. Its not a good deal, doing something is better than nothing…bullshit.

  126. anonone says:

    Of course Dean is right. But as long as Liberals and Progressives keep thinking that a kick in the ass is a back rub, we’ll keep just getting kicked.

  127. cassandra m says:

    The ones without a clue are the people who think that their President can wave a magic wand to get everything he wants AND provide them ponies.

    The process is the process and as long as that process means that you need 60 votes in the Senate, that is the path available. Pretending that there is another, better choice is remarkably clueless. But we don’t expect any better from you, A1.

    This Congress will not redo this bill. Full stop. If you can’t get 60 votes now, you won’t get them next year. That would be the reality. If you don’t get 60 votes now, you won’t get them in this President’s term. He won’t try it again, and the Congresspeople who have endured this so far won’t be interested in reliving this history.

    Pretending otherwise — as Howard Dean is doing — is to show yourself not even paying attention to what has transpired over this year.

  128. anonone says:

    Keep lobbying for the insurance companies and Joe LIEberman, cassandra_m. They’re laughing at you all the way to the bank. And I am sure that the families that will lose their homes or can’t afford food because of the mandated health insurance premiums and government fines appreciate all that you’re doing for them.

  129. anon says:

    This Congress will not redo this bill. Full stop. If you can’t get 60 votes now, you won’t get them next year. That would be the reality. If you don’t get 60 votes now, you won’t get them in this President’s term. He won’t try it again, and the Congresspeople who have endured this so far won’t be interested in reliving this history.

    That is what happened with Bush’s Social Security privatization giveaway, and that is exactly what should happen to this insurance privatization giveaway.

  130. anonone says:

    If he won’t try again and maybe, you know, actually fight for real HCR, then who’s fault is that?

  131. anon says:

    Look… the Senate bill is not social insurance, it is privatization. The social insurance concept is failing because not enough Americans support it strongly enough.

    If voters want their private insurance so bad, let them get their asses back to work and buy it. They’ll come back to us looking for universal health care when they are ready.

  132. anon says:

    More to the point: If voters want their private insurance so bad, let them pay for it without subsidies. The Senate bill supports Republicans by masking the pain and the cost of the private system. If you take away the private subsidies, single-payer or the public option start looking a lot better to voters.

  133. anon,

    The voters support the public option, and they support Medicare buy-in as well. It’s the insurance companies and their best friends in the Senate who don’t support it and who killed it.

  134. A1,

    We can’t pretend the last year hasn’t happened.

  135. anon,

    That’s the system we have now, and it leaves people uninsured. People who want insurance and who can’t afford it. People who want insurance and are turned down because they get sick. The status quo is unacceptable.

  136. anonone says:


    You can’t pretend that this bill is health care reform anymore.

  137. ananie says:

    The voters support the public option, and they support Medicare buy-in as well. It’s the insurance companies and their best friends in the Senate who don’t support it and who killed it.

    The reason they killed it is once people had the option to buy into Medicare or purchase a plan from the government, no one would buy Private Insurance. Think about it. How many people do you know that would trade their Medicare for Private Insurance?

    Answer: NO ONE.

  138. anon says:

    Think about it. How many people do you know that would trade their Medicare for Private Insurance?

    They do it all the time; it is called Medicare Part C. Something else we are going to fix incrementally, gradually. Maybe when we have 80 Democrats in the Senate.

  139. cassandra m says:

    Keep lobbying for the insurance companies and Joe LIEberman, cassandra_m

    And you keep being an asshole, A1. An asshole who continues to have no way to justify his positions without misrepresenting what other people say in order to have something to argue against. You might think about what this conversation might be like if in fact you’d be more honest.

    But I get that honesty is not in your vocabulary.

  140. anon says:

    That’s the system we have now, and it leaves people uninsured. People who want insurance and who can’t afford it. People who want insurance and are turned down because they get sick.

    There are enough of those people to tip any election. If they want public health care so bad all they have to do is vote for it. If they all called Joe Lieberman tomorrow he’d probably vote for the public option.

  141. anonone says:

    I see once again that you have reduced your argument to name calling.

    Saying that I have “no way to justify [my] positions without misrepresenting what other people say in order to have something to argue against” is absurd considering that there are many other progressives arguing strongly against the Senate HCR bill that Joe LIEberman, the insurance companies, and YOU support.

    Facts are facts.

  142. cassandra m says:

    Which is more of your making up the arguments you want to have. Not only was there name calling, but calling you out for lying about other people’s positions so you have something to get your poutrage on over.

    And I’m not here arguing for “other progressives” opinions. I am here arguing for mine, only. Which may be why I don’t need to lie about what you say.

  143. anon,

    They did vote for it.

  144. anonone says:

    I wasn’t lying about anybody’s positions, just pointing out the consequences of the position. And for this, you’ve called me an “utterly immoral bastard” and an “asshole.”


    Keep lobbying for your 60 votes, cassandra_m, even if Joe LIEberman and his insurance buddies get to rob Americans blind. As you say, we may never get this chance again for decades.

  145. uninsured. People who want insurance and who can’t afford it. People who want insurance and are turned down because they get sick.

    UI a fair read of the bill allegedly says that the stipulations that stand in this bill will ensure that people will be fined for not getting private insurance that they very well may not be able to afford.

    As in where insurance companies can fly to the state with the most lax rules and where insurance companies can charge as much as they want for pre-existing conditions that they now must cover. And the tax-payer will have to cover this expense for low-incomes who can’t pay what private corps charge but the middle class will eat this. Up to 17 percent of their income on insurance costs alone, let alone co-pay etc.

    Middle class are the big losers on the way this bill has been set up. They won’t vote for DEMs in 2010 once they see how badly they’re screwed by this bill mandate.

    SEIU President Andy Stern has come out strongly against this bill. There is plenty of room to fix it and it must be fixed.

  146. cassandra m says:

    Lying about my position includes claiming that I am lobbying for anything other than getting something that we can fix. Because even with the weak public option of the House Bill or even weaker originally proposed public option in the Senate bill, you’d still be in the business of trying to fix that.

    The additional lying comes in backtracking from that to pretend that there is something about your statement that points out “consequences”.

  147. anonone says:

    Regardless of your motivation of “getting something that we can fix,” it was not lying to say that you are actively supporting this bill for the sake of 60 votes, just like LIEberman and the insurance companies. That is the truth.

    Supporting a bad bill in the hope that it can be “fixed” later is a bit incongruous with your incessant demand that people explain how to get 60 votes now for an improved version of this bill. If you can’t get 60 votes now, how are you going to get them later to fix it? And if you can get them “later,” then I say let’s wait until then to pass a good bill.

    Meanwhile you just continue to ignore the legal, moral, and financial consequences of the mandate. The financial impact of that on many people’s lives will be very detrimental. This is a bad bill. It should not be passed in its current form at all. It makes no sense to make the health care situation and people’s lives worse in hopes that you can “fix” it later.

    But apparently it is easier for you to ridicule people as clueless and call them names than to actually consider for a moment that they might be right.

  148. cassandra m says:

    it was not lying to say that you are actively supporting this bill for the sake of 60 votes, just like LIEberman and the insurance companies. That is the truth.

    This is a lie.

    And fair readers of this and other threads are going to be quite clear about this. You specifically charged that I was lobbying for insurance companies. Scroll back up and look. THAT is a LIE. No matter how you try to work out your weak rationalizations.

    I do not think that it is more important to hurt insurance companies than to improve the outcomes of people who don’t have insurance now. I have been more than clear — and will acknowledge that you don’t want to hear it, but are willing to lie about it — that getting people without insurance the chance at some coverage is more important that denying insurance companies any profits. You seem to think that this is about capturing insurance companies’ scalps, and if that is true then you were never on the playing field for this effort. Because you still do not — and will not in the near future — have the votes in Congress to accomplish what you want.

  149. anonone says:

    No, cassandra_m, support of this bill is to support the government extorting money from people on behalf of insurance companies.

    People need to eat and pay rent; this bill makes those items at least numbers 2 and 3 on their priority list while making the insurance company profits number 1 BY FORCE OF THE GOVERNMENT.

    In your world, people should be forced to pay unregulated insurance companies’ profits before food and rent. I think that is so utterly wrong that I can’t even believe that people like you consider it to be an acceptable idea.

    Supporting this bill IS to lobby for the best interests of insurance companies, not people who need to pay for health care as well as food and rent.

  150. cassandra m says:

    Supporting this bill is about supporting the ability of people without insurance to get some. As I have been clear over and over and over. And, as predicted, here you are with your poutrage that always elides that.

    In your world, people should be forced to pay unregulated insurance companies’ profits before food and rent.

    And here we go with the clueless again. From someone who pays for insurance converge before he pays for food and rent. Because if your employer deducts your portion of the premium from your paycheck, you’d done exactly that. But getting beyond the need to make sure that you collect up an insurance company scalp instead of getting a better outcome of people who do have insurance (and an additional 30+ million people to complain about insurance rules too) is never going to occur to you. Because the real people in this don’t much matter. Just your ohsosuperior outrage.

  151. anon says:

    Speaking of so-called “tort reform” – if you are truly concerned about cost of malpractice insurance you will support the repeal of the antitrust exemption on the providers of said insurance. To get some competition, you know.

    It’s worth pointing out there are bills sitting in House and Senate committees to repeal the insurance industry anti trust exemptions and strengthen regulation. The Senate version is even cosponsored by Reid.

    Yet another hammer left in the bag.

    Health Insurance Industry Antitrust Enforcement Act of 2009 – Declares that nothing in the McCarran-Ferguson Act shall be construed to permit health insurance issuers or issuers of medical malpractice insurance to engage in any form of price fixing, bid rigging, or market allocations in connection with providing health insurance coverage or coverage for medical malpractice claims or actions.

  152. anonone says:

    Dear cassandra_m,

    If it came down to feeding your family or paying your health insurance, what would you do? Currently, you have a choice. Under the bill that you support, you would not.

    Health insurance premiums are voluntary now. v-o-l-u-n-t-a-r-y n-o-w. Got it? So your example is not applicable. You or I can stop paying for health insurance if we want to or have to.

    And right now, millions of families in America have to make the choice between food, rent, and health insurance. And they choose food and rent. Under your plan, they won’t have that choice any more. They’ll have to pay for insurance company profits first or face huge government fines.

    That is why insurance companies and Joe LIEberman love this version. So if you support this bill as is, you’re essentially lobbying for the profits of insurance companies over the freedom of families to make their own choices relative to meeting their most basic needs. And it does nothing major to reduce costs and the denial of coverage penalties are toothless.

    And there is no way around that.

  153. cassandra_m says:

    How much per year to do pay for your share of the premium that your employer takes from your paycheck? I just did a quick survey among friends (not scientific) and the range is from $2400/year to $6240/year.

    If you were earning 54K per year AND your employer offered insurance for your family, you are unlikely to turn that down. Possible, but unlikely. So you are still on the hook for your share of a premium — and on the hook for your rent and your food. Your employer is paying somewhere between 50 -80% of your premium. This bill largely replaces the employer share of the premium — and you still have to pay both your share of the premium and you have to pay whatever cost sharing (co pays and the like) that are a feature of your policy. This family of 4 may be paying more in terms of the cost sharing, I don’t know. My own survey found family costs from 3K to 16K, but the latter is with a family who had two kids with medical issues this year.

    But it still shows that the coverage is still worth it. If this same family of 4 could get coverage from an employer, they’d still be on the hook for a share of the premium and for their cost haring expenses. Right now, this family without insurance is on the hook for complete share of this insurance — the full premium and whatever cost-sharing required by that insurance. And that presumes you can get the insurance in the first place.

  154. anonone says:


    The point is not our particular details or even the theoretical family of 4 with a median income; the point is that today we have a choice to do what we need to within the circumstances that we live in.

    This bill takes away a fundamental freedom of Americans and extorts us into paying directly into profits of largely uncontrolled and monopolistic private insurance companies, whether we want to or not or even whether we have the money or not. We will essentially become indentured slaves for the profits of private insurance companies without the freedom to say “no.”

    And your comment still doesn’t address the fact that we’d be forced to pay for a service without cost controls and that has toothless denial of coverage penalties.

  155. cassandra_m says:

    The point is not our particular details or even the theoretical family of 4 with a median income; the point is that today we have a choice to do what we need to within the circumstances that we live in.


    The point here is that there are millions of people who need some insurance coverage. You can skip over the costs (which you asked about, BTW) to a family — and most of the families I know of would take this crappy insurance deal over not having any at all, or having to buy their own off of the rack. This is about OUTCOMES — although you asked about affordability and you ignored everything I said to answer you.

    You got an answer you didn’t much like, so you are back to your bobby horse that it is more important to capture an insurance company scalp than it is to get the uninsured some coverage. From your safe perch of not having to do without insurance.

  156. anonone says:

    Dear cassandra_m,

    I did not ask about cost. I said that millions of families in America have to make the choice between food, rent, and health insurance. Many many families will not be able to afford $4,000 per year for health insurance, regardless of what “most of the families that [you] know” think.

    You’re also ignoring so many other factors like the fact that older Americans would pay up to 3 times as much under your bill and others would pay 50% more for pre-existing conditions. So your hypothetical family of 4 with a median income actually says very little about ACTUAL OUTCOMES.

    Perhaps it just comes down to you believing that having the government make all Americans indentured slaves for the profits of private insurance companies is preferable to having some people go without health insurance. I disagree with you.

    By the way, just because I have insurance doesn’t disqualify me from the debate, although you seem to think it is some big “gotcha.”

  157. cassandra_m says:

    If it came down to feeding your family or paying your health insurance, what would you do?

    This is a question about costs. And a question about my priorities for costs. Which I answered you by showing that 1) if this family has employer provided insurance, their outlays are roughly the same (and yet here you are NOT arguing for people who cannot afford their employer sponsored insurance) and 2) that the government roughly takes up the payment of the premium that your employer does. There are no scenarios in the US system of insurance that you have no cost outlays except perhaps for Medicaid. And here you are working hard at dancing away from addressing any real good that this same family that has no insurance now might be able to get with some.

    And I don’t remind you about the comfort of your position already with insurance to impeach your qualifications to debate — but to remind you that it is very easy to privilege whatever principles you think you are arguing for when it is other people’s children who are at risk.

  158. anonone says:

    Dear cassandra_m,

    It is not a question about costs. It is a question about circumstances. You think it is OK for the government to require families by law to pay for the profits of private health insurers before food or shelter or face huge fines. I disagree. It is that simple.

  159. cassandra_m says:

    Keep dancing away from your own question. The fact that you want to deal in abstractions and not in real, live outcomes is noted.

  160. pandora says:

    I’ve been thinking a lot about this, which is a luxury since I’m not living it. But I did live it in my late twenties when we had to buy individual health insurance – which cost more per month than our mortgage and carried a 2500.00 deductible on each of us. We considered going without, but were terrified of losing our house. This bill would have helped us – not everyone, but it would have helped us, and we would have jumped at it.

  161. anonone says:

    Dear cassandra_m,

    The fact that you want to deal in abstractions and not in real, live outcomes is noted.

    Your hypothetical family of 4 with a median income or $54,000 is nothing more than an abstraction. It is not a “real, live outcome.”

    Unfortunately, real live families having to choose between food, rent, and health insurance are the reality. And this bill won’t help many of them. As Obomba noted in 2008 “if a mandate was the solution, we can try that to solve homelessness by mandating everybody to buy a house. The reason they don’t buy a house is they don’t have the money.”

    In your world, I guess everybody has the money.

  162. pandora says:

    Ezra Klein weighs in on cost controls in the bill.

    I just keep reading and reading and reading.

  163. cassandra_m says:

    That median familiy is more real that your stickin’ it to the man bullshit. That media familiy does not have insurance now and would be doing the same stretching of budgets to pay for their employer-subsidized insurance. That is real. There is no difference in who pays the employer part — the government or the employer. Yet here you are screaming about a wide range of working class to middle class people getting subsides to help pay for insurance. And not one peep about the same budget impact this same family would have if they were paying this money out of their paychecks to the same private insurance provided by their employer.

    And the real out come here is not the median family — a median family is not an outcome (why am I explaining this BS to you?) — the real live outcome is that this median family will have a chance to get some insurance coverage where they have none now. And you’ve still not explained why these families should be delighted to continue in that state.

  164. anonone says:

    And you’ve still not explained why these families should be delighted to continue in that state.

    Because being able to afford food and shelter without insurance is a better alternative than being hungry and on the street because the government is extorting their food and rent money for private insurance company profits.

  165. cassandra_m says:

    And skip right over how these same families might pay for employer-provided insurance if it was offered.

    More stickin’ it to the man bullshit that still ignores how much at risk families without insurance really can be.


  166. pandora says:

    I’m still waiting for a reason why we can’t build on this bill…

  167. Progressive Mom says:

    Pandora —

    The Klein article is very interesting, so thanks for posting it.

    But I would posit a few additional items:

    1) Bundled payments aren’t new, and haven’t worked very effectively for cost control. Bundled payments is the new, improved version of payments under DRGs. This has not kept health care costs down, although some would argue it has kept costs from going higher; it has hurt some rural and small hospitals substantially. There is no reason to believe that it will control health costs, although it will have a limited impact on administrative costs for both insurer and provider.
    Bundled payments work best in systems that are totally controlled by one owner: Kaiser-Permanente, for example. Using Klein’s example, in the real world, my mother’s cardiologist doesn’t make sure she’s taking her meds so he can keep her out of the expensive hospital; there’s no incentive for him to do so, because he’s not a hospital employee. And the hospital doesn’t do it, because she’s not their patient any more. (I do it; that’s for another thread!)

    2) Klien seems to think that the threat of being kicked out of a market will be an incentive for insurers to keep costs down. In many markets, it won’t be: many markets will be controlled up to 75% or more by one player (either one whose name starts with Blue or United). You can’t drop the monopoly player. And I’m sure that Klein has noticed that in most markets premium costs are within a few percentage points of each other, no matter how many insurers there are. This isn’t a get-it-cheaper-at-Walmart product. One raises premiums and they all raise premiums. (More like cable, or your cell phone…other monopolies)

    3) The Medicare Commission is a joke. It doesn’t even look good on paper, and it doesn’t work now. And if you didn’t like the idea that women couldn’t elect to get mammograms based on family history (or fear, or need or whatever) every year starting at age 40, you’ll love the Medicare Commission: note that even Klein says its job is to step in when costs rise, NOT when good medical science dictates changes. In other words, they are supposed to find savings, based on medical decisions, whether they exist or not.

    Finally, the individual mandate is not a cost control: it’s profit margin for the insurer. Yes, having younger healthier people does keep the pool’s costs down … but nothing prevents the insurer from raising its profits, raising its overhead with sweetheart executive contracts, or raising its administrative and marketing costs and, thus, raising its rates.

    (There’s also a devilish problem built in around the issue of exact benefit plans and these young, health consumers … but we can’t have that discussion until we actually know if any benefits will be mandated, and which ones.)

    I see Klein’s points, but some of his conclusions are wishful thinking. The health care system’s costs are based on very complex issues and, if the total solution to rising premiums is 1) get younger, healthier people; 2) rely on threats to the insurers; and 3) let the Medicare Commission handle it …. we’re really in deep doo-doo.

  168. pandora says:

    And while we’re waiting for why we can’t improve it, perhaps we should look at the evolution of social security (h/t skindig55 at dkos)

  169. Progressive Mom says:

    Pandora — Speaking only for myself, I think the issue of “building on this bill” is complicated by one fact: every single discussion of health care reform up to this point has assumed a government-run option of some sort.

    In fact, the entire discussion of health care reform (and, for myself, I began to wince early last summer when the President started using the term “insurance reform” and stopped using health care reform) hinged on the fact that it would be the government option, in some form, that would maintain premium costs at an acceptable level. It was a given in the discussions that the insurance industry would never do this on its own. Remember that great conservative fear that we would all drop our employer sponsored plans for the “cheap” government plan? Or that our employers would leave their private plans? Remember all the discussions that lead to allowing a government option ONLY for individuals in very small businesses or those with no access to employer insurance?

    Without any government intervention in the delivery of health insurance, without any government controls on premium costs, without any effort to stop insurance monopolies or anti-trust issues, without any guarantees that people with health issues won’t pay huge penalties for being sick, there isn’t much to talk about.

    For me, it’s like saying: “We’ve eliminated every place to buy groceries in your area, except WalMart. If you buy elsewhere, or you grow your own,you get fined. We will help support poorer people with their grocery bills, so no one will go hungry, through your tax dollars — but we won’t control WalMart in any way. Now, let’s see how we can build on this.”

    I have no freakin’ idea how we build on this. I hope to heaven someone does.

  170. cassandra_m says:

    You can still get a Public Option later. Or Medicare Buy In later.

    But cost control is not just about reducing the cost you pay now. It is still cost control if you slow the rate of growth of health care or of premiums. And those are two different things.

    There has not been a Public Option on the table since summer that was ever going to be especially effective at controlling costs. Because a Public Option that would do that would look like Medicare Everyone Can Buy, and that is no where to be seen. The House bill has a Public Option that is restricted to the numbers that can signup and the CBO did not score this very high as a cost control item. Why? If you limit who can signup there is little downward pressure on premiums. The Senate Public Option was worthless — state exchanges, regional exchanges, but nothing like Medicare Buy In for anyone who wants it that really would have put alot of pressure on prices.

    I am a very big fan of the Public Option and defended it ALOT here in these pages. But what passes for the Public Option now does nothing except give progressives a rallying cry for something that hasn’t been true for a really long time now.


    The hopeful part of the House Public Option was that it was something — wait for it — that you could expand and build on.

  171. anonone says:

    I’m still waiting for a reason why we can’t build on this bill…

    Because the insurance companies will have more money, more lobbyists, and an even bigger gravy train to fight for than they do now.

  172. anonone says:

    OK, cassandra_m,

    Let’s mandate the homeless buy homes and the hungry buy food. Oh, and guns, too. Lets mandate gun ownership. And then cars because that will be good for the economy and people without cars.

    That will solve everything.

  173. pandora says:

    Imagine where we’d be if… we had passed something like this in 1993.

    The hardest thing in this discussion is that the “kill the billers” see absolutely nothing of value in this bill. Nate has 20 questions/20 responses, while I keep reading and reading and reading.

    You see, while I lean toward passing the bill (as a starting point) I’ll admit I’m not certain it’s the right thing to do. BUT, this absolute “kill the bill” approach is seriously turning me off. Truth: it isn’t all bad. There are some good things in the bill. Refusing to admit that – and have a discussion – makes me question where some people are coming from.

  174. cassandra_m says:

    And there goes A1 making up more arguments not in play.

  175. cassandra_m says:

    Nate’s post may be the best of them yet, Pandora.

    I am really clear that this needs to pass, even without the Public Option. As far as I’m concerned, it has been without a robust Public Option since summer. But It was OK then to be willing to settle for a start and fix it later. Why that doesn’t apply now is beyond me.

    But this convinces me that something is better than nothing.

    And this person is not so different from friends of mine who are book artists. They are now living with COBRA and a 2 year old in Arizona. The COBRA runs out soon, there are no jobs with insurance on the horizon and that cannot figure out why people who are supposed to be on their side are calling for this bill to die. They know this is not a great bill. But they want insurance and will work at keeping it if they can get something that is not the rack rate.

  176. anonone says:

    I am so happy that you’re all supporting this rob from the poor to give to the rich scheme.

  177. pandora says:

    So that’s it, A1? It all sucks? There’s nothing worthwhile in this bill? At all? And if we disagree with you then we’re insurance hacks looking to screw over the little guy? Seriously?

    Please, please, please, do not ever complain about someone “insulting” you again.

  178. anonone says:

    The bad far outweighs the good in this bill’s current form. I am sorry to say that, but it is true in my opinion and many others. And if we continue to settle for crumbs and let the LIEbermans of the world control our health care reform, crumbs are all we’re gonna get.

  179. donviti says:

    anonone, I don’t understand why you can’t be happy here. The Dems are in congress, so you are supposed to like it.

    What’s wrong with government picking up half the bill and the Insurance companies not lowering thier rates at all?

    What’s wrong with the insurance companies now getting to raise the rates of elderly 300% to make up the difference of adding “More risky” less profitable folks to it.

    Hey man, this is Delaware Liberal, this isn’t some conservative site telling you how awful this bill is!

  180. donviti says:

    Comment by pandora on 17 December 2009 at 7:02 pm:

    So that’s it, A1? It all sucks? There’s nothing worthwhile in this bill? At all? And if we disagree with you then we’re insurance hacks looking to screw over the little guy? Seriously?

    Please, please, please, do not ever complain about someone “insulting” you again.

    Pandora? Do you buy a Yugo because it has shiny new tires?

  181. pandora says:

    No, DV, I actually read, consider and think.

  182. donviti says:

    as do I.

    so if we don’t kill the bill and I’m not saying that is my position, but if we don’t kill the bill, what are we putting in place that we can’t undo. Sorta like the Donut whole in Medicare and the pricing for drugs.

    I’d be a lot happier if I knew what was going to be given that can’t be taken back once it is signed

  183. pandora says:

    And that is a legitimate question, unlike the Yugo crack.

  184. You do know that the current bill closes the Medicare Part D donut hole don’t you, at least partially. Who says you can’t improve things?

  185. anonone says:

    Um, pandora, where did I “complain” about somebody insulting me? I often point out that when people start calling me things like “asshole” or “utterly immoral bastard” that it usually means that they have lost the argument.

    It is not my intent to insult people personally, but I will ridicule bad arguments mercilessly. So I apologize if anything that I have written in this thread was personally insulting to anybody (except LIEberman and Obomba and Reid).

  186. anonone says:

    Hey Donviti,

    This HCR bill is like Eminent Domain on steroids. Extort people’s hard-earned money and give it directly to private insurance company profits. Fine ’em or jail ’em if they can’t or don’t want to hand over the dough.

    At least they’ll get healthcare in jail (except in Delaware).

  187. anonone says:

    pandora and cassandra_m, just read this:

    “Health Care on the Road to Neo-Feudalism

    I believe that if the Senate health care bill passes as Joe Lieberman has demanded it–with no Medicare buy-in or public option–it will be a significant step further on our road to neo-feudalism. As such, I find it far too dangerous to our democracy to pass–even if it gives millions (perhaps unaffordable) subsidies for health care.

    20% of your labor belongs to Aetna

    Consider, first of all, this fact. The bill, if it became law, would legally require a portion of Americans to pay more than 20% of the fruits of their labor to a private corporation in exchange for 70% of their health care costs.

    Consider a family of 4 making $66,150–a family at 300% of the poverty level and therefore, hypothetically, at least, “subsidized.” That family would be expected to pay $6482.70 (in today’s dollars) for premiums–or $540 a month. But that family could be required to pay $7973 out of pocket for copays and so on. So if that family had a significant–but not catastrophic–medical event, it would be asked to pay its insurer almost 22% of its income to cover health care. Several months ago, I showed why this was a recipe for continued medical bankruptcy (though the numbers have changed somewhat). But here’s another way to think about it. Senate Democrats are requiring middle class families to give the proceeds of over a month of their work to a private corporation–one allowed to make 15% or maybe even 25% profit on the proceeds of their labor.

    It’s one thing to require a citizen to pay taxes–to pay into the commons. It’s another thing to require taxpayers to pay a private corporation, and to have up to 25% of that go to paying for luxuries like private jets and gyms for the company CEOs

    It’s the same kind of deal peasants made under feudalism: some proportion of their labor in exchange for protection (in this case, from bankruptcy from health problems, though the bill doesn’t actually require the private corporations to deliver that much protection).In this case, the federal government becomes an appendage to do collections for the corporations.

    Mind you, not only will citizens be required to pay private corporations. But middle class citizens may be required to pay more to these private corporations than they pay in federal and state taxes. Using these numbers, this middle class family of four will pay roughly 15% in federal, state, and social security taxes. This family will pay around $10,015 for their share of the commons–paying for defense, roads, some policing, and their social safety net share. That’s 15% of their income. They will, at a minimum, be asked to pay 9.8% of their income to the insurance company. And if they have a significant medical event, they’ll pay 22%–far, far more than they’ll pay into the commons. So it’s bad enough that this bill would require citizens to pay a tithe to a corporation. It’s far worse when you consider that some citizens would pay more in their corporate tithe than they would to the commons.”

    The rest is here:

    Maybe this will help you understand my outrage over this bill – and why you should be outraged, too. This bill is legalized indentured slavery to insurance companies. I guess if this article doesn’t change your opinion, nothing will.

  188. cassandra_m says:

    but I will ridicule bad arguments mercilessly.

    Well, wake us up when you get to this part! At least that might be fun.

    But instead you’ve been here with a lot of hot air, excessive posturing, overdone indignation and a demonstrated lack of knowledge of the process, the politics and the bills in question. You run away from your own questions, needing to dance back to your own preconceived notions, lest someone disturb your ohsoperfect rage at the system.

    And what is really fun about that FDL article? If every single American had insurance provided by their employer, that break down of all of that expensive government stays the same. As does the amount of money you pay to insurance companies. The only thing different about the government vs employer insurance is who pays the other part of the premium.

  189. Progressive Mom says:

    Cassandra — I think we’re going to agree to disagree on this bill — but I do take issue with your idea that the summer version of the public option and no public option are equally as bad. And the public option was “dead” in the summer: it passed in the house version. Not perfect, but there’s something to build on.

    If there was any government intervention, or option, or profit restriction, or actual real-honest-to-God oversight, or real premium equality for those with illness in this bill, there would be something to build on.

    Deck chairs on the Titanic, if this passes.

  190. anonone says:


    The only thing different about the government vs employer insurance is who pays the other part of the premium.

    An you accuse others of “a demonstrated lack of knowledge of the process, the politics and the bills in question”??! I’ll say it again: Health insurance premiums are voluntary now. V-o-l-u-n-t-a-r-y

    If this bill passes, you can think about me as you spend your MANDATORY INVOLUNTARY servitude working to line the pockets of private health insurers to pay for lousy coverage. And you can think about me as people lose their homes, jobs, and transportation because the government has put the profits of insurance companies at the top line of all family budgets. And when parents start being put out on the street because they can’t afford to spend one month a year working for Aetna or pay the huge Federal fines and feed and shelter their families , think of me.

    Because to you, that’s all “fun.”

    There aren’t many greater losses of freedom than having the government extort wages from citizens to give them to private companies. It is stealing from the poor to give to the rich. You think that more people having health insurance is the greater good, but buying security for the price of freedom has never been a good deal. To paraphrase Ben Franklin “Those who would trade in their freedom for their protection deserve neither.”

    You can defend Joe LIEberman’s opinion and I’ll defend Howard Dean’s.

  191. cassandra m says:

    but I do take issue with your idea that the summer version of the public option and no public option are equally as bad.

    This is not my idea.

    My idea is that the strong Public Option that would provide downward pressure on health care cost was dead this summer. The House version is weak — it limits the number of people that can join and even the CBO didn’t score this very highly as a cost control measure. But I do agree that even a weak Public Option would have been something to build on.

  192. cassandra m says:

    Because to you, that’s all “fun.”

    And we’re back to the lying so you have something to be superior to, something to argue against.

    Holla at us when you can get honest here.

  193. John Manifold says:

    Brownstein notes that Dean’s college-educated constituency doesn’t have to worry about insurance:

  194. anonone says:

    Do they have to worry about freedom?

  195. pandora says:

    There’s some truth in Brownstein’s article, although I could live without the sophomoric “wine set” name calling. I’m fighting for health care because I believe in it, not because I need it – and that’s a big luxury.