A Major Setback On The Public Option

by: Chris Bowers

Fri Oct 30, 2009 at 15:40


Last night in Quick Hits, art3 alerted the Open Left community to the ugly repercussions of the defeat of the Medicare +5% public option.  Now, it appears quite possible that even if the negotiated rates public option passes as a part of the final health care bill, it will not cost any less than private health insurance plans.  From the CBO analysis of the House bill (page six, PDF):

Roughly one-fifth of the people purchasing coverage through the exchanges would enroll in the public plan, meaning that total enrollment in that plan would be about 6 million.

That estimate of enrollment reflects CBO's assessment that a public plan paying negotiated rates would attract a broad network of providers but would typically have premiums that are somewhat higher than the average premiums for the private plans in the exchanges. The rates the public plan pays to providers would, on average, probably be comparable to the rates paid by private insurers participating in the exchanges. The public plan would have lower administrative costs than those private plans but would probably engage in less management of utilization by its enrollees and attract a less healthy pool of enrollees. (The effects of that "adverse selection" on the public plan's premiums would be only partially offset by the "risk adjustment" procedures that would apply to all plans operating in the exchanges.)

Ouch.  That is pretty awful.  In plain English, it means that the public health insurance option won't cost less than private health insurance options because, on average, the people purchasing it will be sicker and less well-off.   So, even though it will save on administrative costs, its risk pool will force it to charge rates very similar, and possibly even higher, than private insurance companies.

After such a loss of momentum, at this point the public option campaign is just about getting a legislative architecture in place that will allow the public option to be improved later on with only 50 votes in the Senate.  Unfortunately, however, any such improvement will be dicey, given that we apparently lack simple majorities for a stronger public option in both the House and Senate.   So, in addition to still struggling just to get the public option in place, we are going to have to struggle down the road to get a better group of people elected to both the House and the Senate.

In this bleak environment, yesterday the House Tri-Caucus (Congressional Black Caucs, Congressional Hispanic Caucus, Asian Pacific American Caucus) and the Congressional Progressive Caucus all met with President Obama to voice their frustration.  The White House simply described the meeting as productive:

It was a productive meeting that lasted for about an hour. The President congratulated the members on working so hard to get a meaningful reform bill put together in the House.

In a post-meeting interview with Democracy Now!, Progressive Caucus co-chair Raul Grijalva used much stronger language:

[We] basically brought out that now that we're in this stage of having to deal with this negotiated rates that came out of the House, and something much worse coming out of the Senate, on a public option, that we felt-set some parameters of what we felt very strongly about, that the bill still needed to be strengthened; that there had to be cost controls on the private insurance companies, especially with negotiated rates, because they get to set the rates and we have to chase those rates with taxpayers' dollar; and no triggers and no opt-outs, that we feel those are detrimental to the public interest and certainly to constituencies that have lacked the ability to access healthcare in this country for so many years.

That is just for starters, as Grijalva also criticized the White House for catering to Olympia Snowe, and not being a strong enough advocate of the public option. Grijalva also indicated that he would not work to defeat the bill, given that he criticized Senators who have threatened to do the same:

We're facing the most historic vote that any of us are going to take in our careers. And for procedural reasons or for other reasons, to threaten to filibuster, to threaten to scuttle, whether it is Senator Bayh, Senator Snowe, Senator Lieberman, I think they're missing their opportunity with history, and I think the White House and leadership shouldn't allow them to be absent in this fight.

This may be a tough bill to swallow, but with language like this, it sure doesn't sound like Grijalva is looking to round-up Progressives to vote against it anymore.

This bill may very well provide a lot more people with coverage, we may well still get some sort of public option passed, and the Progressive Caucus does appear to have increased its influence.  However, the cost of premiums will continue to rise beyond what are already unacceptable levels, and even without the filibuster we apparently still do not have a good enough Congress to pass transformative legislation.  It is a hard pill to swallow, and a very frustrating day.
Chris Bowers :: A Major Setback On The Public Option

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A Major Setback On The Public Option | 123 comments
so Lucy pulled away the football (4.00 / 1)
surprised? The whole public option debate was nothing but a bait and switch operation from the get-go. Maybe it is time to mobilize for serious reform.

Everybody in, nobody out has a lot more punch than public option please

Bullshit. Bull. Fucking. Shit. (4.00 / 9)
I really hate that "bait and switch" line. It is an egocentric fantasy dreamt up by single-payer activists, who think that the public option campaign was all about trying to trick single-payer activists into generating activism on behalf of a public option.

That's just a flat-out, self-absorbed, intellectually dishonest, egocentric, whining fantasy. The public option campaign was created by single-payer supporting members of Congress--Woolsey, Conyers, Kuucnich, Grijalva, Weiner and others. Its primary goal was two-fold: to actually get a public option, and to increase the influence and effectiveness of the Progressive Caucus.

To argue that it was just a ruse designed by the Progressive Caucus to trick single-payer supporters into making calls to Congress is ignorant, offensive, self-absorbed whining.

No one was fucking trying to trick you. You are accusing people who have been working on little else besides this campaign for months as acting in bad faith all along. That is deeply fucking offensive.

[ Parent ]
Progressive caucus can only do so much (4.00 / 3)
Most of them are good, hardworking folks but simply not enough of them.

I won't argue that we aren't seeing the goalposts moved on us because they are, but just because it happened/is happening does not mean it was a bait and switch.

This is a huge setback. Honestly if this thing gets watered down anymore I'd rather it NOT pass than to have something pass that will only increase costs more and hang an anvil around our necks politically.

[ Parent ]
thank you Chris for that answer (4.00 / 1)

[ Parent ]
calm down, big guy (4.00 / 7)
The public option wasn't created in bad faith.  It was co-opted by those who were negotiating in bad faith.

I have immense respect for the progressives who have worked for years pushing for meaningful reform.

However, I believe that many progressives have become too invested in the current legislation to walk away when it became clear that it was a dog.

A public option that isn't open to a majority (or sizeable minority) of Americans?  That can't use the purchasing power of the Federal Government for cost savings?  That will likely become a dumping ground for private insurance rejects?  Once again we privatize the profits and socialize the losses.

If you told most progressives back in 2008 what we would end up with they would have vomited.  Pelosi couldn't get the votes for Medicare +5%?  Are you kidding me?

I can't predict the fallout from this debacle, as the grassroots doesn't have too many options in a two-party system.  But I think that Obama and Congressional leaders may have lost a significant chuck of their motivated, activist base with this sell-out.

[ Parent ]
not you chris and not the cpc (0.00 / 0)
if there was a bait, it was in the summer of 2008 when hacker was still talking about how his po in a multipayer system would be the transition to sp. even if that is so, it would have nothing to do with you or the cpc. there is no reason for you to take it so personally.

.....

it didn't help to have weak, small and firewalled public options constantly called robust though. but that is another matter.

[ Parent ]
versailles (0.00 / 0)
david below beat me to it and said it better. if there was a bait and switch, imo it was versailles that did it to progressives.
[ Parent ]
could we take a timeout (0.00 / 0)
and focus on an element of reform that could actually SAVE money-- not just shift around who's paying for what?

http://fdlaction.firedoglake.c...

if we allow expensive biologics to go generic after a few years, everybody saves... except the pharmaceutical companies. this point is being lost in the public option melee.

[ Parent ]
The outcome looks organic to me - not a conspiracy. (4.00 / 3)
The determining factor seems to be the resistance of the Blue Dogs. Pelosi seems to have pushed hard for a beefier public option. The Dogs weren't the football holders; they were the opponents, and they were partially but not completely defeated. All the sides fought hard for what they wanted and we ended up with this particular piece of sausage.

On a practical level, I think we should take this (assuming no buried poison pills come up). Politically, I think a push for Medicare for All should mostly wait until the new system runs and we can see the consequences. (Mostly - reminding the public how good it would be is a good idea!)

[ Parent ]
do the math (0.00 / 0)
[ Parent ]
I think it the PO advocates were acting in good faith (4.00 / 3)
They were trying to find a politically feasible way to move towards reform.

The plan was so complex and piecemeal that in order to convince skeptical voters with a short attention span of the merits of this plan, a certain amount of oversell was required.

Conversely, as the plan made its way through Congress, and in the absence of presidential leadership, it was watered down. And the advocates had to accept compromises in order to have a bill.

It's possible to start with good intentions, and then lose one's way.

It was an honest mistake, although one could make a case that they could have known better. Sometimes people have to get burned before they'll learn. One hopes they'll learn the right lesson.

[ Parent ]
Action (4.00 / 2)
There is one thing progressives can do in the long run -- buy into the public option.  If enough healthy people buy in they will be able to keep the rates down.  As the rates go down, it will become more popular while also treating the sick much better than private insurance.

The CBO is just guessing on this.  They can be proven wrong.

Only if (4.00 / 4)
We change the rules regarding who can buy into the public option. Right now it's so limited as to almost guarantee an adverse risk pool.
[ Parent ]
ffl says the exchange will start expanding after 1 year (4.00 / 4)
The House bill would expand access to the new health insurance exchange fairly rapidly. In year one, 2013, only individuals without employer provided insurance and the "smallest" employers (25 or fewer employees) would have access to the exchange. In year two, 2014, "smaller" employers (50 or fewer employees) could access the exchange. By year three, 2015, all "small" employers (100 or fewer employees) would gain access to the exchange, and the exchange Commissioner could permit larger employers (greater than 100 employees) to be eligible for the exchange.
http://fdlaction.firedoglake.c...
[ Parent ]
Its one idea (0.00 / 0)
And it might be necessary. As a small business owner, I think I might be eligible for the public option--if it exists--when it comes into being, and I know I will purchase it if I am.
[ Parent ]
[pounds head on table] (0.00 / 0)
Are you sure you aren't a little too invested in [a|the] [strong|robust]? [Federalist]? public [health insurance]? [option|plan]?

Especially since it's going to be more expensive?

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
Head Banging (4.00 / 3)
I'm all for head banging, but you miss the point.

The only reason the CBO thinks it will be more expensive is they think it will attract an above average number of at-risk people.

If more people sign up for it, the cost will go down.  It is all about the trajectory the public option takes.  If the costs go up because only sick people sign up, then it will spiral out of control.  However, if costs go down at first, it will gain in popularity.

The correct way to handle this is to use Medicare rates.  Some versions of the plan only used Medicare for the first few years, just to get the Public Option started.  However, that isn't necessary, just advantages.  If the plan starts out right, it will do well.  If it starts off in the wrong direction, there will be a problem.

Remember, most people who can access the public option are actually quite healthy.  Young adults make up a large chunk of the uninsured.  So the numbers are there, as long as the private plans don't convinced them all to go that way.

[ Parent ]
But the version expected to pass is *negotiated rates,* (0.00 / 0)
not Medicare rates.

Those who cannot remember the past are condemned to repeat it.

George Santayana, The Life of Reason, Volume 1, 1905
[ Parent ]
Oh, I understood it (0.00 / 0)
It's reflexivity.

And beyond that, I won't go. It's late, and I do have a life.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
I don't think the CBO guesses - (4.00 / 1)
This is very disconcerting, as Chris Bowers point out, that the public option expected to pass will attract only a fraction of the uninsured, and they will be paying high premiums.

The public option is supposed to be the cost stabilizer! This is the reason to have it - to create competition and reduce "the cost of health care." So what does that mean - the cost of health care?

The question we need to answer, seems to me, is this: Will the reform bill, in practice, lower premiums of private insurance, considering there's going to be a mandate for the currently uninsured to purchase insurance?

Those who cannot remember the past are condemned to repeat it.

George Santayana, The Life of Reason, Volume 1, 1905

[ Parent ]
Unless the CBO has a time machine (0.00 / 0)
and can go to 2019 and see what happens, then all they're doing is guessing.  
[ Parent ]
If this is passed (4.00 / 2)
There will be, perpetually, an opportunity for the federal government to shave tens of billions off the deficits, producing many times that benefit for ordinary Americans, just by changing the public option to Medicare + 5. That's a strong position to be in, because we can bring it up every Congress and beat up on the opponents for being both callous to American citizens and reckless with taxpayer money.

There's a lot of good things in this bill, especially no recission and no pre-existing condition denial. Sure I want more, but now that it's clear we can't do substantially better with this Congress I'll be happy to take it. We all complain that Hillarycare didn't go through, for all its faults, and this is better.

The long-term politics will be good too. It's a big win for the Dem party, the most significant reform since Medicare, and in the long term everybody will be forced to say "gosh, they should have listened to the lefties more".

The price is too great (4.00 / 1)
For a couple of minor reforms, which could be implemented with no controversy tomorrow, you're building for-profit health care into the system permanently, with no way of controlling costs. And throwing away the ability to experiment with single payer in the states into the bargain. This is a bad bill, and it should be opposed.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  
[ Parent ]
That's way too negative (4.00 / 1)
These reforms are not minor. The basic result is that anybody, absolutely anybody can buy healthcare at a population-level price. The price will be inflated by the overheads of private insurance - perhaps 20-30% - but that's nothing like the 10-fold or more costs many had to pay because of pre-existing conditions or even the 2-3 fold premium for individual/small business care. No recission is major too - about 1/3 of bankruptcies are caused by people whose insurance refuses to cover their bills. And how can you say "with no controversy" when the insurance companies have successfully resisted for two decades - and when you yourself are raising a stink? It has been tough to get what's on the table.
[ Parent ]
They are minor relative to the scope of the overall problem (0.00 / 0)
Sure, ending rescission (if the insurance companies don't end up gaming the regulations, highly unlikely though that may seem) is good.

And I'd like evidence that "anybody, absolutely anybody can buy healthcare at a population-level price." Got a link?

* * *

Incidentally, I'm glad you said "buy health care," for two reasons.

1. It's untrue. You're conflating buying health insurance with getting care. Insurance is what they buy, not care.

2 I'm glad you agree that health care for profit is now permanently baked into the system. What I can't understand is why you don't view that with any concern. Such a view certainly belies your handle!


I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
1/3 of bankruptcies isn't minor (0.00 / 0)
Not minor at all

I couldn't find the current bill language, but section 113 of the Dingell bill prohibits all pricing variation except by age to a limit of 2:1, by area, as permitted by the states and the feds, and by family composition. So everybody pays the same premium (with those moderate and reasonable variations).

Dingell bill text (search for "sec. 113")

[ Parent ]
"building for-profit into the system" (0.00 / 0)
I think we can all agree that for profit is already in the system, as I am sure everyone who has to decide to actually vote yes or no is aware. I don't see why they should accept your implication that voting no is a vote against for-profit insurance. (I understand why you view it that way.)


New Jersey politics at Blue Jersey.
[ Parent ]
36 million people (4.00 / 2)
Yes, covering 36 million people is a "minor reform".  Spending hundreds of millions of dollars helping working class families afford insurance could be "implemented with no controversy tomorrow".

Thanks for your well though out argument.

[ Parent ]
You're very welcome (0.00 / 0)
I was thinking of rescission and pre-existing conditions, which would have been reasonably easy to pass. I wrote carelessly on the Medicaid expansion, it's true (since my focus has mainly been on single payer vs. public option).

That said, spare me the rhetoric on helping working class families. Nobody who presides over the incredible shrinking public option from 130 million to 10 has any pretension to well thought out argument whatever.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
Yes, covering 36 million BY 2019... (0.00 / 0)
... is pathetic. And such a long way off that there's little reason to think it will happen. (But at least, with a timeline like that, we'll finally be free of "lives are at stake" from public option advocates. That will be a profound relief.)

Sorry I didn't respond right away -- you gave no link for your talking point, so I had to dig out the sourcing on when the coverage would actually take place.

So, to volley back, thanks for your well thought through argument.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
We do have an ace in the hole, kinda (4.00 / 1)
the individual mandate may be unconstitutional: http://www.politico.com/news/s...

Yes, it's a right-winger writing it and it'll probably be right-wingers challenging it in court, but even right-wingers can occasionally be useful.

If the individual mandate ends up being declared unconstitutional, that'll blow up the entire creaky contraption that's been put together in this bill.  The only viable solution, then, other than doing nothing, is Medicare for All.

it's part of obama's 11-dimensional strategy (4.00 / 3)
he got a promise from sonia to rule it unconstitutional

what is that? there are 8 more judges on the supreme court you say?

shit...

[ Parent ]
But if we have a conservative Congress (4.00 / 2)
and individual mandates get thrown out, we may end up with nothing. Exchange-based systems with mandates work pretty well (it's the most common solution in Europe) provided you have adequate cost controls. The cost controls here are probably inadequate, but improving them is a relatively easy road. Medicare for All is a great system, but we'll need a Congress substantially more liberal than this one to get it and I don't see that anytime soon.
[ Parent ]
"Nothing" will run that conservative Congress out of town pretty fast (0.00 / 0)
if voters are made even dimly aware that health care reform has been reversed.

Also, if individual mandate is gone but public option stays, would that work, at least for a few years?

[ Parent ]
Since the purpose of the bill is to bail out the insurance companies... (4.00 / 3)
... the mandate will stay in place. With the IRS acting as the collection agent, I might add. Well done, Dems, on legitimating right wing tax resistance.  

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  
[ Parent ]
Without mandates is very risky (4.00 / 1)
Depending on the distribution of health risks, either you go to a nice functional market with most people in or the whole system collapses and nobody has insurance. I think Stiglitz wrote the paper on that. My impression is the latter outcome is more likely, but it's not known.
[ Parent ]
Get ready to bend over and take like a man, progressives. (4.00 / 1)
Can I become any more cynical? I think not.

"Sometimes I wonder whether the world is being run by smart people who are putting us on, or by imbeciles who really mean it." - Mark Twain
I've often said that the difference between the Ds and the Rs... (0.00 / 0)
... is that the Ds use lube.

I confess. I was wrong.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
Whither public option (4.00 / 1)
" we are going to have to struggle down the road to get a better group of people elected to both the House and the Senate."

This has always been true, the first 9 months of Obama's term might be thought of a reality check on Chris's observation.
(sigh) let's get on with it.

Nobody could have predicted... (2.67 / 3)
... that the net effect of the "progressive" bait and switch for public option would be a bailout of the insurance companies, and nothing else of significance.

Just to be clear: [a|the] [strong|robust] [Federalist?] public [health insurance]? [option|plan]

1. Is nothing like the original Hacker Medicare-style public option, with 130 million enrollees;

2. Provides "universal" coverage only by making the working assumption that "universal" is the same as "a very high percentage"; the bill is in no sense "Everybody in, nobody out."

3. Provides at this moment no path to single payer, since the Kucinich amendment, which would prevent single payer from being outlawed in the states, is not on, and Weiner's HR 676 amendment seems to hang in the balance as well.

In other words, the central arguments that "progressives" made for their "public option" strategery have not come true, and in the process they managed to suck all the oxygen out of the discourse for the only genuine solution on offer: Single payer.

My suggestion would be not to swallow the pill at all. What for?

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

I'm going to just start troll-rating (4.00 / 3)
I going to start troll rating every comment that uses the bait-and-switch line.

You really think that everyone working on the public option campaign was just trying to trick single-payer activists?  that we just spent the last seven months trying to get single-payer activists to make some more phone calls on our behalf or something?

That is offensive and egocentric. I'm sick of it.

[ Parent ]
Sure, I'll use another name (4.00 / 1)
How about, with Alfred Kahn, "banana"?

Consider reading Kip Sullivan's posts and responding to the analysis instead of reacting to a phrase, if not now, then during the post mortem. Because somebody hates a meme doesn't make it untrue; sometimes, quite the reverse, in fact. Kip Sullivan does respectable analysis, with plenty of links. Let me quote a lengthy excerpt from one, just to show that the whole process we're going throw has happened before:


I first heard the "political feasibility" argument from members of a Minnesota health care reform commission in the spring and summer of 1990 when the coalition for which I was working, the Health Care Campaign of Minnesota, started visiting commission members to drum up support for single-payer legislation. I remember very clearly hearing the political feasibility argument on a hot summer day in 1990 in the office of Senator Linda Berglin, a commission member who also chaired the Senate health committee. Berglin, who was and still is from the safest Democratic-Farmer-Labor district in Minnesota, said she wouldn't support single-payer because "we can't beat the insurance industry" (or words almost exactly like those). A year later she was claiming that legislation that relied on HMOs to contain cost would have a much greater chance of passing in Minnesota and that's what she was going to focus on.

Over the years 1992 through 1994, Minnesota's legislature did in fact pass a series of bills (collectively referred to as "MinnesotaCare") that were supposed to achieve substantial cost containment by encouraging faster enrollment in HMOs, and thus establish universal health insurance by July 1, 1997. Of course, it all fell apart, beginning in 1995. Minnesota is no closer to universal health insurance today than it was in 1990 when I was first advised by my betters about how politically infeasible single-payer is and how politically feasible the HMO approach would be.

A half-dozen other states have suffered the same lesson. Legislative leaders, egged on by left-of-center groups that didn't know much about health policy but which maintain close relations with Democrats, thought they could achieve universal coverage by funneling more tax dollars through "managed care" insurance companies. This occurred recently in the state of Massachusetts where "Romney-care," a program that requires Massachusetts residents to buy health insurance from that state's bloated insurance industry, was enacted in 2006. The program is having a very hard time staying afloat. All these multiple-payer state initiatives foundered because they did not contain cost.

It is now the summer of 2009. You can imagine my reaction to people who claim single-payer isn't politically feasible but that other proposals that leave the insurance industry at the top of the health care food chain are. I want to get out my guitar and sing in a sad, tremulous voice, "Where have all the flowers gone .... When will they ever learn?"

How many times must universal coverage advocates rush onto the battle field to promote a multiple-payer solution and get slaughtered before they realize they can't get to universal coverage that way? How many defeats will it take till they know that universal coverage without cost containment is not politically feasible?How many times can they be fooled into thinking that there are ways to cut costs other single-payer?


It's deja vu all over again!

As far as troll-rating... We "little single payer advocates" are quite used to being excluded, and we've already been censored by White House. So, go ahead!

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
the best response to being excluded (0.00 / 0)
The best response to being excluded to to regularly claim that the entire public option campaign was just about tricking single-payer activists. Which is exactly what the bait-and-switch line does.
[ Parent ]
Read the quote and the links and respond to them (0.00 / 0)
Because they don't say what you're saying they do. I mean, start with "... just [only] about tricking.... " Where does that come from??  Reread, and you'll see that I'm not making that claim, nor does Sullivan. And those posts are dated July and August of this year. Surely you must know that the exclusion and censorship started long before then. Back off the personalia and put your analytical hat on, for pity's sake.

I mean, come on. Hacker had a Medicare-style, 130-million enrollee public option with a glide path to single payer. That's what "progressives" started out by selling, and none of it came true.

Now we've got a 10-million enrollee public option, that's not like Medicare, and single payer (as of this writing) is outlawed at the state level and the Weiner amendment might not even hit the floor, despite Pelosi's promise.

So, you don't like "b____ a____ sw____".

What's your suggestion? "Banana"?

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
Multipayer can work (0.00 / 0)
It works in Germany, France, the Netherlands, and Switzerland, OTTOMH. There are many more. And even without cost controls, multipayer universal care is better than what we have now (ask people from Massachusetts if they want to repeal their reform).
[ Parent ]
You know how multipayer works in Germany? (4.00 / 3)
Everyone (with a few clearly delineated exceptions) under a certain income level is required by law to be in the government-run system.

That's the only way you can ensure that the risk is shared and that you don't have healthy people opting out.

The mandates proposed in the "public option" merely require individuals to buy insurance--any insurance. Then market forces are supposedly going to gradually get more and more to buy the government plan. It's roundabout and by no means certain.

It's frustrating talking about the same misunderstandings again and again. I hear people suggesting giving individuals the option of "buying into" Medicare--when Medicare is a single-payer system. If it had been optional, it would have crashed and burned long ago under the burden of the sickest patients as healthy people chose not to buy in and the private insurers cherry-picked the healthiest and wealthiest of the rest.

There's no way of doing this that avoids taking away some of the "choice" our politicians prate vapidly about.

[ Parent ]
That's an interesting point - (0.00 / 0)
when Medicare is a single-payer system. If it had been optional, it would have crashed and burned long ago under the burden of the sickest patients

Is this the future of the Public Option that's expected to pass? --to crash and burn?

Or, are we back to pass it to improve it, and Dems take the credit for getting the other reforms the bill contains - no recission, no prexisting conditions, no higher premiums based on a person's age.

Those who cannot remember the past are condemned to repeat it.

George Santayana, The Life of Reason, Volume 1, 1905

[ Parent ]
where is the political capital to improve the bill? (4.00 / 1)
Once it's passed, health care reform will be dead for the next twenty years. Any isolated cries to improve it will be met with "We passed a piece of paper with 'health care reform' at the top, what more do you grunting plebs want?"

Given how much effort it's taken to get this far, I'm not sanguine that the bill will be revised, except to water it down even further.

Someday we will have to stop procrastinating, we will have to stop making rosy but utterly baseless predictions about being able to fix things in the future and actually solve the problems we're presented with.

But that day is not today.

[ Parent ]
how interesting (4.00 / 4)
Other than the inflammatory and false "bait and switch" charge, I thought lambert's comment really laid out his position quite well.  

New Jersey politics at Blue Jersey.
[ Parent ]
Thanks, I think. (0.00 / 0)
You need to read the links and read the analysis before claiming "false." They've been posted often enough, to resounding silence.

* * *

As far as inflammatory... Well, start at 130 million, end with 10. What's to be expected?

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
I think that public option please activists operated in good faith (0.00 / 0)
on the other hand I think that they were willfully blind to the bad faith actions of Celinda Lake, the Herndon Alliance, and HCAN't.
[ Parent ]
a good public option probbaly would have been the fastest way to get to single payer (4.00 / 1)
so now we have to spend energy trying to get to a good public option.  this wasn't unforeseen at all, but it is annoying that more work is being piled up for us.  

i still say progressives should celebrate that the structural framework for a government health care programme that can expand into universal healthcare has been laid down, despite the best efforts of the insurance companies and pharmaceutical companies and asshat senators.

[ Parent ]
With single payer experiments outlawed in the states... (0.00 / 0)
... the structural framework is not there.  

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  
[ Parent ]
how hard will that be to undo? (0.00 / 0)
certainly not as hard as changing a 'co-op' system to a public healthcare system, let alone creating single payer healthcare from scratch.  moreover, health care as a political issue will remain live because the bill is not going to do anything substantive about prices, not be adopted immediately, and not curb insurance conmpanies' or pharmaceutical companies' power quickly enough.

i agree with you that this is very watered down, but expecting anything more is unrealistic when the farthest left position that was adopted by large numbers in congress was a robust public option and the concept of a public option barely makes it through the senate.  particularly once pelosi started being pelosi again.

don't get me wrong - i'm only suggesting disappointment and disenchantment over bitterness.  i had the first two going already, whcih i think my expectations were lowered.  

[ Parent ]
I think you don't really believe this (4.00 / 4)
If you really think all the public option advocates are liars and sell outs (which is what I gather here from your use of scare quotes around "progressives" and the bait and switch stuff) - why are you bothering?  Isn't this place just like reading Red State for you or something?  Chris is a "progressive" blogger engaged in a massive conspiracy to trick you into giving up on single payer, right?  (A conspiracy so bold and well managed that it evidently doesn't ban people demanding single payer, even as it exists to suppress single payer somehow).

No, you're still around, day after day trying to persuade the major bloggers to take up your cause, because somewhere you know they are sincere about improving health care in America.

So all these accusations you make are just rage, or some kind of trollish effort to provoke, or some other psychological ploy I don't get, but either way it's really irritating and you should knock it off since its dishonest on your part to keep implying something even you don't actually believe.

[ Parent ]
Yawn (0.00 / 0)
Psychologizing bores me. I can't imagine why it doesn't bore you.

* * *

I'll post the links again. Here they are:

Confront the analysis. A reality-based community should be able to do that, no?

* * ** *

As for "progressives" with the quotes -- When a faction starts off by advocating for a public option that's Medicare-like, has 130 million enrollees, and has a path to single payer, and ends up with a public option that's not Medicare-like, is going to get 10 million enrollees, and outlaws single payer in the states, that's pretty hard to consider as "progress" -- except in the direction of giving the insurance companies a bailout. So, based on performance, "progressives" with quotes. I'm not the one who caused the problem by inventing a phrase; "progressives" are the ones who caused the problem with the strategy and policies they carried out and advocated for.  

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
a convenient omission I suppose (4.00 / 1)

I asked Adam Sarvana, press secretary for Rep. Raul Grijalva (D-AZ), co-chair of the Progressive Caucus, if the subject of his wanting an amendment on Medicare + 5% rates in the public option came up in the meeting. Actually, it didn't. Most of the discussion, Sarvana said, was about House members' opposition to public option compromises like triggers and the opt-out. The Congressional Progressive Caucus remains on the record as 100% opposed to the trigger AND the opt-out clause, which has not really been prominent in the debate. Everyone assumes that whatever passes the Senate on the public option will represent what must appear in the final bill, but House progressives are, for the moment, not backing down in their opposition. But clearly, the White House wanted to feel out that opposition and see if they could potentially break it down.

http://news.firedoglake.com/20...

Z

Opt-Out vs Level-Playing-Field (4.00 / 4)
Personally, I'd rather have Medicare+5% with the opt-out then level-playing-field without the opt-out.  This post explains why.  The whole thing boils down to making sure the plan is successful from the beginning.  Opt-out won't hurt the plan itself, but level-playing-field might.  As long as the program is successful it can be expanded, but if it fails, it fails for all time.
[ Parent ]
Agreed (0.00 / 0)


Those who cannot remember the past are condemned to repeat it.

George Santayana, The Life of Reason, Volume 1, 1905
[ Parent ]
I just hope when this is all over ... if it goes the way it appears it is ...... (4.00 / 1)
... that people lose their delusions concerning obama and this party.  Actually, especially obama ... I think there has been a fair amount of cynicism regarding the democratic congress as it is ... becoz we still got too many people making excuses for him and not looking at his role in this whole mess.

This article covers a little bit of his sell-out to big parma interests:

"It's the deal that has no name," Whitehouse told HuffPost Wednesday. "It's been sort of a mystery to see how this is a sort-of-deal that no one acknowledges, yet everyone honors. So I'm hoping that we can get a more profound contribution [from PhRMA]."

The deal has indeed had an unusual history. It was announced in June, but details were withheld. When those details were reported over the summer, the parties to the deal said the deal that was outlined in a memo was not, in fact, the deal. Later, the deal was publicly debated and defended during the finance committee mark up. And the bill that Baucus unveiled contained the details of the deal that the parties had previously said had not been struck.

Drug makers, in their deal with Baucus and the White House, have offered to contribute $80 billion over ten years to the reform effort and $150 million to buy ads backing health care reform and Democratic candidates. Much of the contributions come in discounts to seniors for name-brand drugs. But drug makers set those prices to begin with. PhRMA argues that the drug industry is being squeezed dry and any more than $80 billion will cost jobs and potentially cost its support, PhRMA insists.  

http://www.huffingtonpost.com/...

Z

We'll never know what Big Pharma would have done (4.00 / 1)
if the deal hadn't been made.
Points against Obama for that one.

Drug makers, in their deal with Baucus and the White House, have offered to contribute $80 billion over ten years to the reform effort and $150 million to buy ads backing health care reform and Democratic candidates. Much of the contributions come in discounts to seniors for name-brand drugs. But drug makers set those prices to begin with. PhRMA argues that the drug industry is being squeezed dry and any more than $80 billion will cost jobs and potentially cost its support, PhRMA insists.


Those who cannot remember the past are condemned to repeat it.

George Santayana, The Life of Reason, Volume 1, 1905
[ Parent ]
With all due respect (4.00 / 10)
No offense intended to all the people who worked their butts off for this -- Chris, Mike, and a host of others -- but it now looks as though the Bill To Preserve, Protect and Defend the Profits of the Health Insurance, Pharmaceutical and Health Care Industries In Perpetuity by Making the Halt and the Lame an Offer They Can't Refuse, Come Hell or High Water -- is now about to become law, just as many dyspeptic and disagreeable leftists predicted when this whole godawful rowing toward the God of Universal Healthcare first began, back at the dawn of Hope and Change some ten moths ago. A last minute Deus ex Machina? Or Fix It Later, perhaps? Again, my apologies to the laborers in the vineyards, but I doubt it, just as I doubted at the outset that this was a whole lot more than an agonizing charade.

I shouldn't say, charade, I suppose, as it's not my intention to mock the efforts of those for whom this was an honorable and hard fought battle, the honest and decent folks who tried to square the circle on something which seemed somewhat more possible, at least superficially, than it had in the past hundred years. Well fought, I would say, and something good may yet come of it. At the very least, the predators and parasites will have a level playing field, a captive audience, government guarantees, and so may graciously permit us, if we can afford the premiums -- if anybody can afford the premiums -- to have a) portability, b) an end to rescission, pre-existing condition exclusions, per-occurence and lifetime caps, and c) access to the chaplain of our choice when our disposable income fails to be equal to the task our benefactors have set us.

A little credit must be due to us also, though, don't you think, for seeing this outcome in advance? No, I suppose not. Like the people who opposed the Iraq war, we were wrong to be right. Nostra culpa.

It would be nice if hope and change could be managed a piece at a time. Sadly, it doesn't look as though that's going to be the case. Washington in flames, whether metaphorically (if we're lucky), or literally, if our bloated congresscritters continue to feast and snooze, appears to be what it will take.

Well, okay then. I've had my say. Shall we now discuss subsidy and reimbursement rates?

These progressive activists deserve credit IMO ... (0.00 / 0)
... at least they tried.  I don't quite buy that they knowingly used the bait-and-switch ... could be though ... but I think their heart was in the right place.  What I think is a lot more likely is that they've been coop-ted to an extent into believing in democratic operatives who exploit them ... or are maybe being exploited themselves.  The most frustrating part though is these activists' infantile refusal to consider that possibility.

The bottom line was that things seemed to be humming towards a decent PO a week or so ago with a robust public option percolating in the house and the senate coming together for a public option as well.  Then the stories came out ... several ... of obama pushing for triggers due to some nonsensical bipartisanship desire to get one damn republican vote.  Almost immediately, the robust PO fell apart in the house and then a few days later, when reid didn't do the rahmbama administration's bidding for triggers, lieberman threatened to filibuster.  Coincidence?  I highly doubt it.

Z      

[ Parent ]
And part of the reason that I feel that we haven't been baited-and-switched ... (4.00 / 1)
... by at least this writer ... is that if that was his plan all along, he wouldn't be so critical of what appears to be the likely results.  He'd be promoting it as a good plan.  

Z  

[ Parent ]
Calling Chris Bowers dishonest (4.00 / 4)
is a slander of the first order, unworthy of anyone who contributes here. I agree with Lambert on many issues, but I think that he should apologize. We all knew going in that genuine universal health care was a big ask in the present political climate. Whatever my disagreements about tactics and strategy, particularly with President Obama, I just don't see the point of accusing people of motivations which, to put it mildly, are totally implausible.

Be angry. Be very angry. Just don't attack our friends because they're more available -- and more vulnerable -- than the people we should be attacking.

[ Parent ]
I've got no compunction about calling obama dishonest ... (0.00 / 0)
... he kept saying he was for the PO, but when it appeared that the tide was finally turning in that direction, he showed his true colors and pushed back.  And this certainly ain't the first time he said one thing while he helped effectuate the exact opposite.

obama is no ally.

I don't think that it is as implausible as you do that bowers can be dishonest ... but I don't think that he was in this case ... almost everyone is dishonest to some extent.

Z  

[ Parent ]
We're all adults here (4.00 / 1)
We all dissemble from time to time for what we feel is the greater good. Presidents are afflicted with this disease in a more aggravated form than the rest of us, but only because a) the stakes are higher, and b) precedent is a difficult thing to overcome.

Isn't this where humility comes in? If you believe in democracy, you ought to go easy on lying to people for their own good. Yeah, any enterprise is more difficult to manage if every proposal results in a crowd of agitated idiots blocking all the exits -- think teabaggers here -- but consider this: if everyone could be sure that their opinions would be heard, and an attempt made to understand the reasons for them, perhaps there'd be less idiocy, less hysteria, and who knows -- maybe even the managers might learn something.

[ Parent ]
OK, what phrase would you suggest? (0.00 / 0)
The phrase that I generally use is the "progressive" b___ a___ sw___  -- and, yes, I do have cites for A list bloggers doing the switch that I'll use in my own post mortem when this is all over.

My ability to write in English is functional, and believe me, if I wanted to write "Chris Bowers does the b___ a___ sw___," I would have. I don't, because these are systemic issues we're confronting.

If people want to personalize matters as a strategy for shooting the messenger, they are certainly free to do so; we "little single payer advocates" are used to it.  Personally, I view the almost total A list front page blackout of single payer material as far more damaging to real people in the real world, not to mention damaging to the "progressive" brand, but some prefer personalities to policy.

However, if the net effect is not to confront the analysis that a "b___ a___ sw___" is what happened, that's not something a community that used to claim to be reality-based should be doing.

Here are the links. When "progressives" dust themselves off after this one and conduct a post mortem, as I certainly hope they do,  this material should figure in their required reading:

"b___ a___ sw___"

reply on "b___ a___ sw___"

"b___ a___ sw___" and the polls

Back in the day, Hacker's public option was 130 million, Medicare-like, and was promoted as a glide path to single payer. "Progressives" made all those claims, many times, while excluding single payer alternatives.

Now, we've got a public option of 10 million after some years, that isn't Medicare-like, and single payer is outlawed on the state level (no Kucinich amendment) and the Weiner amendment might not even come to the floor.

Call it what you want; "banana" if you want. If you don't like b___ a___ sw___, then what's your suggestion?

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
Point taken (4.00 / 1)
You didn't name Chris, that's true. Saying that you slandered him was probably as over-the-top as the exchange between the two of you, and I apologize for it.

I don't speak for progressives, either with or without the quotation marks, but I do think that it's possible to believe, as I do, that we're likely to get very little out of Washington on any issue dear to us until power relationships in that city are fundamentally restructured, yet still offer credit where it's due to those who've risked personal burnout to get as much for us as they can from the system as it exists.

Co-existence and mutual respect, in other words -- at least until it's much clearer what will actually work. If it ever is.

[ Parent ]
Then the co-existence and respect should begin... (4.00 / 2)
... with covering single payer stories (in particular, activism) and taking single payer analysis seriously as a policy alternative. Just give it oxygen.

There's no such thing as a civil discourse that's based on news blackouts, silencing, censorship, and exclusion, which is what single payer advocates have gotten from the press, the White House, the Democratic Leadership, and "progressives." [links on request; this is not hyperbole.] When the blackouts, silencing, censorship, and exclusion stop, the co-existence and mutual respect will begin. (I hope I shouldn't have to say that for me this is about the discourse, not about me.)

Until then... I'm sure you're familiar with the emblem of the Democratic party? And the way to get its attention?


I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
With this much I agree (4.00 / 1)
Single-payer shouldn't have been dismissed as politically impossible without any further ado, even by those who believed that it was a waste of scarce resources to pursue it. If you'll indulge me in one more metaphor, there are many paths to God, or to Enlightenment, if you prefer, and judging by the furor in Left Blogistan, enough people to pursue all of them.

If you're working for a Senator or Representative, have counted the noses, and are damned sure that you don't have the votes for single-payer, and can't get them, no way, no how, then it's perfectly natural to look at the next item on the list. The same holds true for President Obama, assuming that he's an honest broker -- and I'd have to see a lot more evidence before I dismissed that notion out of hand. (Of course, I did expect, and would like to continue to expect, a lot more from him, such as genuine leadership. That doesn't make me a fool, I think, unless I persist in it until the truth hits me over the head with a window-weight.)

If you're outside looking in, as most of us are, I see no harm in making the case for single payer, and if you're Daily Kos or whoever, to allow the case to be made in your venue, and to treat its advocates as something other than wayward children, who aren't as smart as wonks and therefore shouldn't play where the adults are talking about serious matters.

Ah, well.... People will have their say about this, and will do things which others don't approve of. If we can just avoid treating each other the way Stalin treated Trotsky, I'll be happy enough, I guess.

[ Parent ]
Silly me (0.00 / 0)
I had this idea that what was politically possible could be changed. You know, like civil rights or women's suffrage. Or slavery (and the IRS acting as a collection agency for the insurance companies rather looks like that, wouldn't you agree)?

Not snarking on you. The decisions by the people with bigger megaphones than mine were taken at some point in 2008. One of those decisions was to deny single payer oxygen. Until shown otherwise, I'm assuming that decision is still in place. So, civility will begin when that policy changes (which, needless to say, isn't up to me). Not having started this, we may have to finish it...  

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
The long haul (4.00 / 1)
Of course it can be changed. When I talk of civility, though, I'm not talking about mere politeness. Malcolm X wasn't polite, and he spoke without deference to his enemies' good opinion of themselves, but he didn't make the mistake of assuming things about them which weren't evident in their actions.

The progressives you accuse of putting their fingers in their ears whenever you tried to get them to devote themselves to what you consider to be the correct course of action didn't necessarily do it because they were corrupt. In most cases, I'd say that it was because they thought it made more sense to concentrate on getting what their own experience told them was all they could expect. Having come to that conclusion, they stopped listening to anyone who disagreed about what was possible -- go away, we're doing this now, or something of the sort.

That's a judgment call. If you asked me, I'd say that it was a tactical judgment, not a strategic one, and that it was therefore a mistake. With health care reform -- to give it the modest name which they've given it, and which it doesn't actually deserve, for all the reasons we're both aware of -- tactics have a way of becoming strategy by default, and that's never a good thing if you're looking for fundamental change.

Don't give up on them. If you turn out to be right, and I think you will, they'll learn, especially if you're around to teach them, and can avoid insulting them while you're doing it.

[ Parent ]
That certainly doesn't seem likely to me, I'm afraid (0.00 / 0)
You're making this all about one person, and that's not right.

1. "The progressives you accuse of putting their fingers in their ears whenever you tried."

No, the "progressives" who did put their fingers in their ears when anyone tried, not just me. I mean, PNHP is a well-regarded organization, 17,000 strong, with built-in credibility because they're doctors. Was any attempt made to use that resource? No. They went with HCAN only.  Was there any coverage of single payer actions? No. I mean, when Margaret Flowers risks arrest at Max Baucus's hearing, you'd think that would rate a post. But no. Heck, FDL even had an HCAN staffer running one of their siloes. Any single payer coverage from him? Of course not.

2. "I'd say that it was because they thought it made more sense to concentrate on getting what their own experience told them was all they could expect. "

Sure, nobody's saying that a blogger shouldn't advocate for what the blogger wants -- even if the 130 million enrollee, Medicare-style public option they advocated for dwindled into the 10 million enrollee public option with single payer outlawed at the state level. And even if the conservatives know how to leverage pressure from the left, and "progressives" just try to shut it down.

However, what happened was that the big "progressive" blogs shut down single payer. The whole faction, all the big megaphones, gave it no oxygen at all. It wouldn't have cost them a THING in terms of "concentrat[ing] on getting what their own [rather minimal, wouldn't you agree] experience told them [to] expect" to open up the discourse to single payer advocacy as well. All they would have had to do is do what the blogosphere used to be able to do: Cover stories that our famously free press won't cover.

Instead, the big "progressive" blogs chose to act in the same way the press does, and they shut the discourse and the stories down. Actions like that have consequences, as we know when the hippies were shut out from the press coverage on Iraq: (1) if the policy fails, bullshit will be called, and (2) the censors -- and if you don't like that word, use "gatekeepers" -- deserve no presumption of good faith.

Well, the policy did fail (130 to 10) and it has fallen to me to call the bullshit. If it hadn't been me, it would have been somebody else. And if they want to re-establish a presumption of good faith, all they have to do is give single payer oxygen again. Let 'em find somebody they like to do the coverage, if they're so trivial minded as to refuse to do the right thing in policy terms because of what they've decided to dismiss as a personality conflict.

3. '... can avoid insulting them while you're doing it..."

Feeling insulted is not the same as being insulted. Some feel insulted by the speaking of unseasonable truths. Some feel insulted for tactical purposes. Others pretend to be insulted as a "Look! Over there!" strategy. Who can really be sure? What I do know -- I can't say b___ and sw___ without being troll rated*, so I'll say "banana" -- is that the case for "banana" has never been addressed or refuted by anyone on these threads, including the moderator doing the troll-rating. It's a serious line of analysis, carried on over multiple posts (see upthread). That the moderator "hates" something is, surely, not incompatible with that something being true, yes? Heck, why don't you give it a shot and do a post on it? Maybe they'll front page it! Give 'em a chance to do the right thing, why not?

NOTE * Some might call that an insult.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
However, here's an opportunity (0.00 / 0)
Right here, to start cleaning up the discourse. I mean, who can argue that people being arrested and going to jail for Medicare for All isn't a story that deserves to be covered?

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  
[ Parent ]
Progressives haven't (4.00 / 2)
Progressives have not used bait and switch in my opinion.  Versailles has.  Repeatedly.  I don't think the term was aimed at Chris, really.

Just my opinion.

[ Parent ]
I don't think it was aimed at bowers either (0.00 / 0)
I don't think the term was aimed at Chris, really"

Chris is the one who took it so personally.

Z

[ Parent ]
See above (0.00 / 0)
This is a SYSTEMIC issue.

If I want to call people out by name, I will.

And if people want to argue about personalities instead of policy, they're free to do so, though I consider it a distraction.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
the problem is your tone (0.00 / 0)
i agree with your pioint that this is a strucvtural issue and the place of progressives in that structure is worth analysing.  but by posing it in a polarising and confrontational tone, you're doing a hella poor organising job.  which is exactly the opposite of what you would want, i would think.
[ Parent ]
I think it was (0.00 / 0)
Lambert has been tearing a strip up and down here and at Correntwire about "progressives" selling the public option.  It's a long record of ill-faith accusation that goes well beyond this one comment today.
[ Parent ]
Beanbag, anyone? (0.00 / 0)
The links to the putatatively ill-faith accusation are on the thread. To my knowledge, the links, the points made, and the history have never been addressed, not once.

Another way of saying this:

When "progressives" with big megaphones start by selling -- and wishfully continue to try to sell -- a program that's going to be Medicare-like, cover 130 million people, and provide a glide path to single payer, and "progressives" end by selling a program that's not Medicare-like, covers 10 million, and outlaws single payer experiments in the states, then by gawd somebody ought to be tearing a strip, and that duty seems to have fallen to me.

I do understand that the messenger is always shot, so that doesn't concern me. Personal isn't the same as important. But nobody's willing to confront the analysis. So forgive me for not taking the pearl-clutching on all this seriously.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
it's not good to be right too far ahead of everyone else (4.00 / 2)
Especially in American politics. Just ask Al Gore.

If you point out the iceberg the ship's about to founder on, you will be met with hoots of derision and accusations that you're deluded, pessimistic, and a killjoy, and how dare you suggest that this glorious masterwork of human ingenuity could ever be damaged by a lowly iceberg.

Then when the ship does crash, they will turn to you and whine and bitch about why you didn't make them change course while there was time, and curse you with their last breath.

No, it's best just to have tunnel vision, to see nothing but what's in front of you. That way when disaster strikes you're just as surprised as all the other fools aboard.

But if you are cursed with foresight--and make no mistake, it is a curse, as the Greeks understood and expressed in the myth of Cassandra--the best you can do is accept your lot with resignation and continue to strive to communicate yourself to others. For who knows? They just might listen next time.

[ Parent ]
Yeppers (0.00 / 0)
I think it's rather hilarious that "progressives" are and have treated single payer advocates in exactly the same way that the neo-cons treated the hippies in Iraq. Plus ca change...  

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  
[ Parent ]
I'm reminded of that quote in Hamlet (4.00 / 2)
where Polonius says he will give the players the kind of treatment they deserve, and Hamlet replies "God's bodikin, man, much better. Use every man after his desert, and who shall 'scape whipping?"

Even if the public option advocates deserve whipping--and I don't think they do, nor is it anyhow up to mortal judgment to decide whether they do--you should treat them much better.

If the goal is to have your ideas vindicated, then the smart thing to do is swallow your pride, to be gracious, and to continue the fight.

[ Parent ]
Huh? (0.00 / 0)
It's not about me personally.*

Niceness begets niceness. Things will get nicer when "progressives" give single payer oxygen. Doesn't have to be me, at all. It's the policy that counts.

NOTE * But thanks for the psychologizing on "pride." I've found that when people can't answer with an argument that's on point, that's what they fall back on. It's an interesting phenomenon.  

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
what can I say? (0.00 / 0)
Sometimes being right just isn't enough. Human nature being what it is, it is not often that full credit is given to those who are right.

I have no quarrel with your arguments. I am fully cognizant of their justice. I have made the same arguments elsewhere. But where we differ is this: I don't accuse people of being deliberate liars, and I am willing to ascribe to human error and folly what you insist on ascribing to malice.

I am willing to forgive a thousand times a thousand, and allow people to save face, if it means we can get what we want.

If Gandhi can willingly submit to imprisonment as a terrorist for his cause, if MLK can willingly submit to being beset by dogs and firehoses for his--surely we can emulate their example. All that's being asked of us is civility, after all, not being thrown in jail.

[ Parent ]
I like this the best - (0.00 / 0)
c) access to the chaplain of our choice when our disposable income fails to be equal to the task our benefactors have set us.

emphasis added.

Those who cannot remember the past are condemned to repeat it.

George Santayana, The Life of Reason, Volume 1, 1905

[ Parent ]
there is no honor in capitulation (4.00 / 2)
There is no honor in accepting this crap. Demand no mandates upon any citizen unless they can buy into a tri-care or medicare plan.

Pass all that other crap... helping those who can afford private insurance.. that's great for them (except for the continued skyrocketing prices).

Progressives should not vote for this bill as is. Draw lines in the sand a mean it.. robust P.O. still should be the compromise.... and help define the reasons why we have come so far in two short election cycles but have much further to go.

Giving these centrist senators and Blue Dogs this bill will only make things worse by keeping the Dem waters muddy.

I effing didn't vote for Mitt Romney so president Romney could deliver Massachusetts mandates to all.. dammit! And I damn sure didn't work day and night so progressives could compromise at that level.

Some faction of the D party needs to stand for something.... or the electorate will just keep bouncing back and forth between conservadems and republicans. Frankly I don't blame them.. if this is all Dems are willing to do.

It's not like this bill would do anything till 2013 anyway. And the economy as well as a better informed number of people on the health care issue is all on our side... if we don't just give it all away, at least for five years.

[ Parent ]
some of us are single payer advocates (0.00 / 0)
but take into account the limits of what can be accomplished in a specific time and context and then set out aims accordingly.  

you weren't going to get a single payer system through this debate once the house progressives decided not to advocate for it, and so your choices were - kill the bill, use the bill as a good time to talk about health care and single payer, and advocate for changes to the bill that would make single payer feasible in the long run (i.e. establishing a healthy, and more effective government run health care plan).  

so kudos for doing the second, but my hypothesis is that the third is quite important in american politics in order to avoid the myth that government is ineffective and the private sector solves all - even in situations of clear moral and social imperative and economies of scale - and understanding that incrementalism is the american way.

'i told you so' while people are upset, certainly isn't going to help advance radicalism very much :)  but i appreciate continued discussion of single payer healthcare which in the end is the best we're going to do - or the closer we get to it the better :)

[ Parent ]
Hold on a minute (4.00 / 2)
The CBO says the public plan's premiums would be higher than the AVERAGE premiums charged by private insurers. But this is because it has higher-risk enrolees.

A better comparison would be to compare the premium each plan would charge for the same person. Given what the CBO says -- each has the same deal with providers, but the public plan has lower admin costs -- the premium should be lower for the public plan.

This should accomplish the goal of pushing private insurers to lower rates or, over time, taking away their business.

this is a good point. (0.00 / 0)
For some people with reasonable means and expensive care requirements, the PO may still save them where private ins would be completely unattainable.

[ Parent ]
More than that (4.00 / 1)
If the PO rates people the same way private insurers do, e.g. by age, then in each case it should provide a lower premium.

It may still have higher AVERGAGE costs if it has a lot of older people.

But apples to apples, it provides a lower cost alternative.

[ Parent ]
I don't believe it works like that. (4.00 / 2)
I don't believe individual enrollees would be charged based upon their own risk profile.  You get charged a flat rate and that rate, collectively, must cover the costs of the entire pool.  

This is an inherent flaw in the system.  It isn't a problem if insurance is an option.  But once you accept the premise that everyone must be covered, it is idiotic to set up a system whereby carriers have an incentive to cherry-pick insureds.  

Someone suggested that some countries used a risk-adjusted reimbursement scheme.  I think that is a great idea.

If you want to maintain a private-sector scheme, that is fine. Just set up a regulatory structure that insures that carriers are competing on factors that we want competition on (e.g. administrative efficiency) and not things that we don't (e.g. applicant selection).  

[ Parent ]
This post on TPM explains (0.00 / 0)
[ Parent ]
Can we all take a deep breath… (4.00 / 2)
...and then start spreading the word that this is a fairly useless public option? When the headlines for Baucus's bill hit a few weeks ago, I remember several people (still) asking me, "What's a public option?" I have to believe that once more people got up to speed its favorability ratings and polling spiked. I'm not sure how to get the word out about this bill's shoddy-ness, but we really need to, so we can have an informed populace weigh in again.  

"This ain't for the underground. This here is for the sun." -Saul Williams
Yeah, seriously, hold on (4.00 / 2)
We're talking about INITIAL rates, not longer-term rates that are likely to go down over time as more and more companies drop private insurance benefits because of rising premiums and lower revenues. Which will force people to buy individual insurance. Which is likely to be a better value with the public option. Which will make public plans more affordable and private plans more expensive. Adverse selection works both ways, and so long as public plans are good ones, over time more and more people will migrate to them, making them cheaper over the long run than private plans. And the government can speed this up by subsidizing public plans aggressively. And even if it doesn't, this is still a likely long-term trend.

"Those who stand for nothing fall for anything...Mankind are forever destined to be the dupes of bold & cunning imposture" -- Alexander Hamilton
migration (0.00 / 0)
if the costs aren't at least the same, the only people who will migrate are those who need more healthcare.

time works against the po, and with adverse selection, if initial costs are not good.

[ Parent ]
I understand your frustration, Chris (0.00 / 0)
I too am frustrated that it is so difficult in our system to get elected officials to act in the public interest.

However, I am not surprised that a result of the current proposed Congressional legislation  might be to have public option insurance cost more. It is still a good thing. Yes, less healthy people will gravitate towards it, mostly because it is likely that a public plan will cover needed procedures that private plans make great profit in denying. (And will continue to deny at even higher levels in the future.) That is a large population that will finally be adequately insured.

Even though the current legislation is deeply flawed, it is something, and having something in place at least makes possible future improvements.

I am less concerned about inadequacy of the present legislation than I am about the prospects of its passage. I am not sanguine about getting Lieberman's cooperation, and think there is much less than a 50-50 chance of this. I mean, the guy tried to keep Obama from being elected. I think it very likely that, like Republicans, he would like to see Obama fail. I don't see healthcare legislation happening without budget reconciliation. Hope I'm wrong.

If we go the reconciliation route, (0.00 / 0)
then by God, we'd better improve this. If I were Grijalva, that's what I'd be saying. If Nelson, Lincoln, Bayh, and Lieberman won't vote for this, then let the real Democrats write the bill, and let's go for the narrowest majority possible.

[ Parent ]
Tough when the *House* can't do better (4.00 / 2)
Last week the Progressive Caucus, Pelosi, and the netroots tried to get Medicare + 5% through the House, and failed. Even if the Senate could get Medicare + 5% through reconciliation, we might not be able to get a reconciled Medicare + 5% through the House. Besides, I don't think the Senate will go that far. The rough whip count in the Senate of 52 or so is for a level playing field - I don't think even reconciliation gets a Medicare + 5% through.

Right now Reid is pushing something very close to this. I think he'll get it too. He's playing chicken with the resistors, but the resistors are becoming aware that filibustering is political death - Democratic voters will eviscerate any filibusterers. The only one I'm really worried about now is Lieberman, who seems to have a few screws loose. The fact that the House bill is so similar puts another locomotive in Reid's train - his bill now looks to be "conventional wisdom".

[ Parent ]
Make it simple and go to the core of the problems of our political system (4.00 / 2)
Start a campaign to elect candidates that promise to vote yes on one issue, the most important one:  purely public financed campaigns.  If we can get that changed, we can regain control of our political system by peaceful means.  If we can't, we are not likely to get much done at all peacefully.

Z

Yes, this is the answerr (4.00 / 1)
And health care was the easy problem.

Financial reform would have been harder, had there been any.

Climate will be harder still.

It's rents again. A portion of the rents the insurance companies get from the mandate (say) will go to the parties, and a portion of that will go to the think tanks and the strategerists and the consultants, and a portion of that will go to the press.... Everybody takes a cut, and the whole filthy system needs to end

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
Where's the PO's level playing field access to customers? (4.00 / 1)
IMO the real fight now should be about expanding access to the PO and the exchanges. Every citizen should have access to a health plan created with their tax dollars and administered by their government. There's a very compelling fairness argument here that's not being made. Fighting for Medicare plus five is a very long shot for victory. Fighting for open access is compelling and doable.

More generally, the idea that we're going to create health care exchanges with open, transparent pricing for all and then tell whole classes of people and employer purchasers that they're ineligible to purchase in the exchange, neuters the buying power of the exchange (including the PO) and is an unfair and arbitrary (and illegal) denial of government services to the exempt classes.

In short, the price for negotiated rates must be open access to all. The health care exchanges and the public option must have the same, level playing field access to customers that private insurers have.

"Don't take much, does it, elected Democrats, to get your balls tucked up." Cf.

CBO is not God (4.00 / 3)
As I noted in the comments of the quick hit, this CBO analysis has assumptions heaped on top of assumptions. Maybe they're right, maybe not, but just because CBO predicts it doesn't make it so.

Even if you accept all of CBO's assumptions and the conclusion that follows, the PO rates for sicker, less well off people will still be better than that category of insureds would get from private insurance. To be sure, this wasn't the primary objective of PO supporters, but this is still a benefit for people who traditionally get the worst of it in our health care system now.

"Don't take much, does it, elected Democrats, to get your balls tucked up." Cf.

Risk Adjustment (4.00 / 2)
It should also be pointed out that the planned health exchanged includes risk adjustment, which means that plans that take in higher risk people (on average) get money from plans that take in lower risk people (on average).  The CBO realizes that but also thinks the risk adjustment won't be perfect.  As Chris quoted:

The effects of that "adverse selection" on the public plan's premiums would be only partially offset by the "risk adjustment" procedures that would apply to all plans operating in the exchanges.

So even the worst case scenario shouldn't be a complete disaster.

What I'd really like to see sneaked into the bill is a different enforcement mechanism.  People who do not sign up for required insurance should be automatically enrolled into the public option.  That would get us closer to 100% and get healthier people into the plan.

Perhaps that is the kind of tweak that could be passed in reconciliation after the fact.  (Assuming it is budgety enough.)

Ooh, I like that tweak (0.00 / 0)
It would be nice to have a painless and safe automatic choice, as anybody who agonized over Medicare D could tell you.
[ Parent ]
Yeah, good idea. I like that tweak too - (0.00 / 0)
Not only does it contribute positively to the insurance pool of the public option, considering people who don't seek out insurance are probably healthy. It also takes us away from penalizing or criminalizing people who either won't comply with the mandate or can't afford to and fall outside the lines of the subsidies, whatever they are.  

Those who cannot remember the past are condemned to repeat it.

George Santayana, The Life of Reason, Volume 1, 1905
[ Parent ]
Well... (0.00 / 0)
It also takes us away from penalizing or criminalizing people who either won't comply with the mandate or can't afford to and fall outside the lines of the subsidies, whatever they are.

Probably not that so much.  After all, they would still need to pay their premiums.  Failure to do that would still be illegal.  And the problems for those that really cannot afford it wouldn't change.  They aren't supposed to exist with the subsidies, but they still will, I'm sure.

However, many will just not get around to signing up or think they can get away with it.  Just pulling a number from nowhere, I'd guess about half of those who wouldn't sign up otherwise would be brought into the system this way.

[ Parent ]
I've always favored this approach (0.00 / 0)
I've always hated the individual mandate, which I view as a necessary evil (with emphasis on the "evil" part), and what I hate even more is the idea that the government would fine you as "punishment" for not subsidizing big insurance companies/politicians' campaign contributors.

To think that a bill that's supposed to be providing people with health insurance would not only not provide insurance but take away people's money to boot, would be hilarious if it weren't a sad commentary on the nature of our political system.

I've always supported the idea of, instead of a fine, the government simply automatically signs people up for an insurance plan.  Of course I'd prefer the automatic default to be the public plan, but I don't know if that'd be fair (or more importantly, have the votes).  What I do know is that this would not only be more fair and productive than some stupid fine, but it'd also save people who don't have the time, energy, or inclination to do research on insurance plans a lot of trouble, which mitigates one of my biggest complaints about the individual mandate.

[ Parent ]
Wyden (0.00 / 0)
In plain English, it means that the public health insurance option won't cost less than private health insurance options because, on average, the people purchasing it will be sicker and less well-off.

One would think that this also makes the Wyden Amendment a key focus now.  

One more time! (0.00 / 0)
The portion of an earlier the post that the moderator -- no doubt inadvertantly -- failed to address. Je repete:

Just to be clear: [a|the] [strong|robust] [Federalist?] public [health insurance]? [option|plan]

1. Is nothing like the original Hacker Medicare-style public option, with 130 million enrollees;

2. Provides "universal" coverage only by making the working assumption that "universal" is the same as "a very high percentage"; the bill is in no sense "Everybody in, nobody out."

3. Provides at this moment no path to single payer, since the Kucinich amendment, which would prevent single payer from being outlawed in the states, is not on, and Weiner's HR 676 amendment seems to hang in the balance as well.

In other words, the central arguments that "progressives" made for their "public option" strategery have not come true, and in the process they managed to suck all the oxygen out of the discourse for the only genuine solution on offer: Single payer.

My suggestion would be not to swallow the pill at all. What for?



I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  
give us a way of understanding how you to get single payer (0.00 / 0)
and one that fits with the context of american politics as you see it and addresses some of the real world problems that the horrendous system that exists now have.

i understand, i think, the train of thought thatyou're following, because i felt the same way about 'immigration reform' in 2006 - it was a joke, and the advocates pushing for it were selling out.  but it's hard to argue.

what is quite clear to me, and what makes the most sense to me, is that if as much energy were devoted to empowering the the people who are affected by this issue and building institutions like community organisations, trade unions, etc., as is towards lobbying, policy issues, contacting elected officials - that would do a lot to change the landscape more fundamentally and additionally help resolve the question of how far to the left you could ask for and you should ask for.  but it is hard to know if this compromise is approrpiate without asking the uninsured and underinsured.

[ Parent ]
strategy question - not as much a question of intent (0.00 / 0)
and one that fits with the context of american politics as you see it and addresses some of the real world problems that the horrendous system that exists now have.

i understand, i think, the train of thought thatyou're following, because i felt the same way about 'immigration reform' in 2006 - it was a joke, and the advocates pushing for it were selling out.  but it's hard to argue.

what is quite clear to me, and what makes the most sense to me, is that if as much energy were devoted to empowering the the people who are affected by this issue and building institutions like community organisations, trade unions, etc., as is towards lobbying, policy issues, contacting elected officials - that would do a lot to change the landscape more fundamentally and additionally help resolve the question of how far to the left you could ask for and you should ask for.  but it is hard to know if this compromise is approrpiate without asking the uninsured and underinsured.

[ Parent ]
If the public option would be more expensive (0.00 / 0)
doesn't that debunk the theory that insurance company profits is the reason for high premiums, that they gouge their customers to make a profit?

The theory on controlling costs is the public option doesn't need to turn a profit, so it would naturally be cheaper and the insurance companies would have to bring their premiums down to the level of the public plan.

Well, if the profits aren't the problem, then that means we're not looking at the real reason for high premiums and whether or not we have a complete private system, public and private hybrid, or single payer, it'll still be expensive.

What is the real reason for high cost?

It seems administrative costs are the problem. Hospitals fear bankrupcy with Medicare +5, why? It doesn't reinburse in rural communities enough for hospitals to pay their bills. Well, ok, why are hospitals and doctors bills so high?

We spend a little too much time hating the insurance companies to really deal with that question.  

not insurance company profits - administration costs (4.00 / 2)
insurance company profits are not the primary problem, it's the administrative costs in a multipayer system both on the insurance and provider side. (which btw, is one of the reasons the po in a multi payer system was and is stupid as policy.

the wasted administrative costs are at least $350 billion per year. for comparison, we were fighting over $110 billion over ten years for a po (and that's best case, making a lot of assumptions i don't buy).

i hate the insurance companies because they compete on cost by denying, not providing, healthcare. that is their business model. but that also would not be changed by a po.

costs on the provider side are harder for me to get a handle on, but certainly it's been a big problem to let the ama have a role is setting costs (they've skewed them towards specialist and away from primary care -- which is one of the reasons we have too few primary care docs).

[ Parent ]
Then I don't see how there is anyway of solving this problem (0.00 / 0)

[ Parent ]
problem solving.... (0.00 / 0)
if universal healthcare and cost control are the goals (and i think they have to be - the first as a human rights issue and the second because the first depends on it), then i also, at least at this point, don't see how a public option in a multi payer system does "solve the problem" -- what we are getting from deecee is built on first institutionalizing the economic parasitism of the insurance industry and for profit providers (big pharma, etc) on healthcare delivery.
[ Parent ]
Huh? (0.00 / 0)
That doesn't say anything.

What is causing the costs to be high? If a public option can't control costs, then the problem isn't the insurance industry, it's the costs for a hospital/doctors to deliver care.

I don't see how you solve that problem. Plenty of other countries have solved that problem with multi payer systems, and even entirely private systems (Netherlands), so what is so special at us that we can't seem to solve it?

It is doctors making too much money? Is it the cost of delivery is too expensive? why?  

[ Parent ]
trying again.... on problem solving (0.00 / 0)
If a public option can't control costs, then the problem isn't the insurance industry, it's the costs for a hospital/doctors to deliver care.

i don't think this is so. guess i did a lousy job of explaining so will try again.

multi payer (non profit!) systems have worked only when very very tightly regulated (via t.r. reid).

multi payers systems don't work in weakly regulated markets (with or without a po), in part because the business model depends on denial of care not delivering healthcare... and that leads to a lot of unnecessary administrative overhead, not only at the insurance company but also at the providers.

here are some links on the overhead issue that will explain it better than i can:

http://content.nejm.org/cgi/co...
http://worldfocus.org/blog/200...

please let me know if i'm still being too opaque.


[ Parent ]
profit incentive does contribute to administrative waste though (4.00 / 1)
e.g. an incentive in investing in marketing rather than provision.  further progits themsevles - whatever they are - are money that could have been used more effectively from a consumer vantage point.
[ Parent ]
Not exactly (4.00 / 1)
The costs are higher because they are largely limiting the pool to the poorer and less healthy.  If the costs are similar when corporate insurance cherry picks the best pools and the PO gets the (statistical) dregs, then that means the PO is doing well at dealing with costs. (Of course, by limiting the competition, we are ensuring that the PO can't impact prices across the board, which is counter productive.)

Support a Pennsylvania Progressive for Governor - Joe Hoeffel
[ Parent ]
actually we spend too little time hating insurance companies (4.00 / 1)
consider two choices:

a system in which there are multiple administrators each with a legal and cultural incentive to put making the most money over all else and and who are not scrutinised by anyone with power and who collectively don't negotiate prices with anyone...

a system in which there is a single administrator with a legal and cultural incentive other than making the most money ovedr all else and which is scrutinised for bureaucratic waste by large numbers of people with power and which collectively negotates prices with providers / insurance companies, etc.

we don't have either, but the profit incentive is part of the problem here - it's not the wholeproblem, just as CEO pay and the disparity between CEO pay and workers' pay is not in other contexts - but it is a useful heuristic in making a point and has actually more substance than the latter two.

[ Parent ]
how is it bad that large numbers of people are going to have access to health care? (0.00 / 0)
especially the most ill, the most likely to get dropped, etc.

i wish the solution had been different to what has happened in this debate, but i will tgake this solution in a heartbeat, provided it doesn't undermine in the future the development of a universal public health care system that minimises administrative costs and waste.

A Major Setback On The Public Option | 123 comments
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