Reasons for Public Option Optimism

by: Chris Bowers

Fri Oct 30, 2009 at 19:00


Let's not go into the weekend too pessimistically.  Via The Big Hurt in the comments, Jon Walker points out that, in the House bill, the public option might become available to everyone in America as early as 2015.

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.

In theory, by 2015 all employers, and therefore all Americans not on Medicare or Medicaid, could start using the new health insurance exchange for health care. This would give nearly everyone the ability to choose the public option if they wanted.

Much of this would depend on the commissioner of the insurance exchange, but it is still very good news. If a public option is part of the final bill, and if this provision is also included, then we would only be a couple of steps from achieving something very close to Jacob Hacker's original vision of the public option. Those steps would be:

  1. Convincing the insurance exchange commissioner--which would really mean convincing President Obama--to open the exchange to everyone in America in 2015.

  2. Tying the public option to Medicare rates sometime between now and 2015.  On this front, Representative Grijalva is pushing for a floor vote on an amendment for the Medicare +5% public option.  If he succeeds in getting this vote, then we will at least know how many more votes we need to reach 218.
So, it is actually still possible that we can pull off the original vision of a public option, tied to Medicare rates, that is available to everyone in America.

So yes, we suffered a setback in the House, but the campaign is far from over.  If we can get a public option, a provision that potentially allows it to become available to everyone in America by 2015, and a floor vote telling us how many more votes we need to tie it to Medicare rates, then we will have a clear path to achieving a truly robust public option.

Chris Bowers :: Reasons for Public Option Optimism

Tags: , , (All Tags)
Print Friendly View Send As Email
Reasons for Public Option Optimism | 53 comments
If it's a level playing field (0.00 / 0)
Why should some people be kept off? An option away from the gougehappy insurance companies is very popular and I think it's a very strong political selling point.

I really hope we get a vote on Medicare + 5%. I would love to see the Blue Dogs squirm trying to vote against a 100 billion + deficit reduction!

How hard WERE the blue dogs whipped, anyway? (4.00 / 2)

 The blue dogs all claim to be "fiscal conservatives" who worry about the deficit over anything else. Yet here they are, standing in the way of a cheaper health-care bill than the one that's being sent to the floor.

 I can't believe it would have been all that difficult for Pelosi, Hoyer, and the rest of the leadership to make the blue dogs very, very uncomfortable about their hypocrisy.

 So why didn't that happen?

"We judge ourselves by our ideals; others by their actions. It is a great convenience." -- Howard Zinn

[ Parent ]
Seriously, I can't believe that this point isn't being drilled in harder (4.00 / 2)
Jon Stewart should be all over this, if he isn't already (I don't watch TDS regularly).

In a just world, the Blue Dogs would from now on be laughed off a stage any time they mention their commitment to "fiscal responsibility".  Actually, in a just world the Blue Dogs wouldn't be anywhere near any position of power.

[ Parent ]
can 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 ]
Without the robust PO (0.00 / 0)
this provision doesn't really matter, because people aren't going to be able to afford the drugs, generic or not.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.
[ Parent ]
To be clear (4.00 / 1)
I'm not saying ignore the biologics provision.  Just don't fight against that to the exclusion of the PO.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.
[ Parent ]
can't afford generic drugs? (4.00 / 1)
if a drug doesn't cost anything to make, it doesn't cost anything to buy. like aspirin and tylenol knockoffs.

most drugs that people without insurance take are generics. getting a prescription might cost money (you pay that to the doctor) but the drug (percoset, say) is cheap.

this issue really is completely separate from the public option debate. we have to address it separately, and forcefully.

i'm totally pro-PO. i just don't think it should be our only concern here.

[ Parent ]
first sentence should say (0.00 / 0)
"if a GENERIC drug doesn't cost anything to make, it doesn't cost anything to buy."

if there's a patent on it, it could cost nothing to make, and pharma companies could charge thousands of dollars for it.

[ Parent ]
Are you saying (0.00 / 0)
that generic drugs don't cost anything to manufacture, ship, store, etc.?  Yes, they're cheap, but they're not free.

Furthermore, my argument was that without the PO, it's not going to matter much, because no matter how cheap the biologics are, people without insurance won't be able to get them, just like they have trouble getting cheap drugs now.  Remember, there's that pesky little necessity of needing to go see a doctor to get the prescriptions, not to mention all the checkups, etc.  If you can't afford that, you can't get the necessary medication, even if it's free.  Without a robust PO, people won't be able to afford these drugs, one way or another.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
costs (0.00 / 0)
you're right, i was not speaking literally. generics are cheap, not free.

i don't think you have a clear understanding of the costs of health care. a doctor's visit to get a prescription will cost maybe $100, $200 at the most. an expensive biologic drug will cost $1000/month or more, and if you're taking it for a chronic condition that cost will continue every month for the rest of your life. a generic drug will cut that medication cost by 90% or more.

[ Parent ]
Apparently, you think I'm an idiot. (0.00 / 0)
I'm one of those people you think can afford all the costs associated with any of these long-term treatments, even with insurance.  You're flat out wrong.  I'd go bankrupt in a heartbeat, and I'm one of the luckier ones.  It sickens me to think that elitist fucks like you are the ones I have to rely on to be my "allies."

Go take a flying leap, asshole.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
Sorry. Calmer now. (0.00 / 0)
Shouldn't have done the name-calling.  That was wrong.  My apologies.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.
[ Parent ]
But according to Billy Tauzin's bio at PhRMA.org, (0.00 / 0)
when he joined PhRMA as its president in 2005 he took up two of the most important causes of his career: "To help ensure patients everywhere continue to have access to the miracles of medicines, and to ensure that innovative biopharmaceutical research thrives, improving and saving lives everywhere." Do you dispute the motives of this fine public servant?
[ Parent ]
What does it take? (0.00 / 0)
What we're seeing is Obama's bill, from the secret deal with Big Pharma in January all the way through having Max Baucus take point in the Senate.

If Obama's not already convinced, what will convince him?

And equally seriously, well, let me do some math. 2009, 2010, 2011, 2012, 2013, 2014, 2015... That comes to six years.

Face it. The goal of the Democrats, as a party, was to bail out the insurance companies with the mandate. They achieved their goal. I think something on the order of the kind of story that's almost never front paged here is in order. Given that everything else has been tried.

Alternatively, we could offer the commissioner a pony?

NOTE I guess the bright side is that we won't have to listen to the "People are dying!" rhetoric any more...  

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

And of course by six... (0.00 / 0)
... I mean seven, give or take. Hey, I'm an English major!

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 ]
Well I would be more impressed (0.00 / 0)
with Walker's "discovery" if I didn't know that almost the exact same provision was in HR3200 when introduced in July

The wide spread impression that most employers and all employees with employer supplied insurance were locked out of the Exchange/Public Option rested on a massive fail in reading comprehension to start with combined with a similar epic fail as a result of confusing CBOs score on "enrollment" in the PO by 2019 and "eligibility". That CBO still projects only 6 million enrollees does not imply that eligibility was ever limited to a "small sliver" of Americans. The whole thing was some combination of incomprehensiom of the actual content of HR3200 along withsome deliberate misrepresentation among the Wyden/HR676 'Single Payer Now' crowd.

Is this provision in the Senate bill too? (0.00 / 0)
And if so, then why is Wyden having shitfits?  Unless you're saying that HE (or rather, his staff) lacks reading comprehension skills.
[ Parent ]
Well my reply went somewhere (0.00 / 0)
I just read throughthe original HELP Bill and it doesn't look like Wyden's Free Choice Act is responsive to it at all, the proposed structures being much different and near as I can see no barriers at all against participation in "Gateways". The Wyden Bill seems presented as a clear alternative to the "Exchanges" of HR3200 and assumes some of the barriers against large employers plus th auto-enrollment language of HR3200 rather than the much different Kennedy-Dodd Bill which after initial passage out of HELP seems to have largely dropped out of the discussion with Baucus and the Gang of Six taking a fresh departure against which Wyden's Bill was both an alternative and a reworking of the competing HR3200
[ Parent ]
Who is this exchange commissioner? (0.00 / 0)
And why does s/he get to be in charge?

Is it an elected or appointed position?  If it's appointed god help us, since Obama will probably just give it to another Clintonista.

The bill says, (0.00 / 0)
starting on page 131 (HTML-friendly formatting and emphasis by me):

Subtitle E-Governance
SEC. 241. HEALTH CHOICES ADMINISTRATION; HEALTH
CHOICES COMMISSIONER.
  1. IN GENERAL.-There is hereby established, as an independent agency in the executive branch of the Government, a Health Choices Administration (in this division referred to as the ''Administration'').
  2. COMMISSIONER.-
    1. IN GENERAL.-The Administration shall be headed by a Health Choices Commissioner (in this division referred to as the ''Commissioner'') who shall be appointed by the President, by and with the advice and consent of the Senate.

[....]


Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.
[ Parent ]
Great (0.00 / 0)
The Obama White House has steam rolled its way past the Senate at every opportunity. Its appointments have sped through that body.  And they have routinely fought for their more progressive appointees (not like those hapless conservative appointees, who they have left twisting in the wind.) Beware the Conservadem who tries to oppose a good appointee (no matter how much of a financial interest you and your spouse have in turning this into a health shock doctrine.)

There is little reason to leave this decision up to an appointee other than to avoid responsibility. I'd love to be wrong, but I don't see how that is good for us.


Politics is the art of the possible, but that means you have to think about changing what is possible, not that you have to accept it in perpetuity.

[ Parent ]
If the GOP is the Party of No, (4.00 / 2)
the Democrats are the Party of Punting.

We've got a few good Dems in both Houses, but they are far outweighed by the corrupt and the pusillanimous.

[ Parent ]
Ummm... (0.00 / 0)
The Obama White House has steam rolled its way past the Senate at every opportunity. Its appointments have sped through that body.

  1. That's kinda how it's supposed to work.  Unless the President nominates incompetent boobs, the Senate shouldn't get in the way of the appointments.  The Senate's responsibility is to ensure competency, not ideology.  (Sadly, they've fallen down on the job even in that area.)
  2. There are 514 appointments that need to be filled, of which only 267 have been filled (at the time I'm writing this).  How long is the Senate supposed to take for each one?  Even if they confirm one a day, it's still going to take 2 years for all those appointments to be filled.  If we only double that to 2 days per confirmation, then the last appointments wouldn't be filled until the end of the President's first term.  If the President doesn't get reelected, then we're looking at positions that are filled for at most only a few days before the next administration comes in.

And then there's the little thing where we have Republicans holding up appointments, such as the Surgeon General who was nominated months ago and only confirmed yesterday.  That's not exactly fast, you know.

As much as I agree with you about Obama's anti-progressive choices for all these positions, complaining about the speed with which they're being confirmed by the Senate does not add to that argument.  Nor does this:

There is little reason to leave this decision up to an appointee other than to avoid responsibility. I'd love to be wrong, but I don't see how that is good for us.

There is every reason to put this decision into the hands of an appointee.  Neither the President nor the congress have the required expertise, let alone time, to be making those decisions.  They already have their jobs.  We need to have someone who can focus on running the exchange full time.

To see what the Commissioner will be in charge of doing, turn to page 132 of the bill and read section 242, titled "DUTIES AND AUTHORITY OF COMMISSIONER.  (It goes well into page 136, so it's long enough that I don't feel like copy and pasting it here, especially since it needs reformatting to make it readable on the net.)  Do you honestly think all of that is something the President or congress should be attending to in addition to everything else they already do (or don't do, as the case may be)?

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
Ummm..... (0.00 / 0)
I'm a little lost as to what you are objecting to. Or maybe you're lost as to what I'm objecting to.

"the Senate shouldn't get in the way of the appointments"...but it is doing that, and the appropriate metric is compared to other presidents. This one has been slow.  I know that Republicans are trying to slow appointments.  But 1) no one is fighting them (which contributes mightily to the speed at which they are confirmed, as opposed to people like Geithner, who they did fight for) and 2) the Republicans don't have the votes to stop anything, on their own. (I don't know why you think that competence and not ideology are the only relevant things the Senate can consider - but obviously Republicans will not go along with that.)

My point is that we have no reason to believe that the Obama administration will appoint and then fight hard enough, and that the Senate will accept, any appointee who will do what Congress and the President are unwilling to do directly.

I wasn't suggesting that Congress  should do everything that the Commissioner has been charged with. I was talking about this, from Chris:

Convincing the insurance exchange commissioner--which would really mean convincing President Obama--to open the exchange to everyone in America in 2015.

That's the decision that I think is an attempt to avoid accountability. And I don't see a reason for avoiding accountability on that decision if you are trying to do the right thing.

Politics is the art of the possible, but that means you have to think about changing what is possible, not that you have to accept it in perpetuity.

[ Parent ]
Perhaps we're agreeing without realizing it? (0.00 / 0)
It sounds like you're objecting to the way things are currently being run in the Senate and wanting them to be run the way they were intended.  I'm pointing out the way they were intended to run while offhandedly acknowledging that that isn't how things are actually being run.  So it sounds to me like we basically agree, but we're coming at it from two entirely different points of view.

For example, you said:

2) the Republicans don't have the votes to stop anything, on their own. (I don't know why you think that competence and not ideology are the only relevant things the Senate can consider - but obviously Republicans will not go along with that.)

This is true.  It is also true that Reid has allowed Republicans to do this through the "painless filibuster."

As to your parenthetical statement, the reason is obvious.  Because competence is all the Senate should be considering.  The President's nominees are part of the executive branch.  Part of the Senate's job is to be a check on that branch, but not to effectively dictate who it may appoint nor to hobble it completely.  The only time ideology should matter is when the nominee's ideology would prevent them from being competent (e.g. Harriet Myers, Gonzalez, et. al.).  That doesn't mean I do not acknowledge the fact that the Senate (and especially the Republicans) make their decisions based on ideology more often than (if not to the exclusion of) competence.  However, I'm not sure how you write into any bill the criteria which the Senate should use for confirmation purposes, since they'll just decide whatever they're going to decide anyway, and then justify it however they like.

So to reiterate, I think we basically agree, but my primary argument comes from the "here's how things are supposed to work" angle, while your argument is from the "here's how things actually work" angle.  Or have I misunderstood your argument?

Convincing the insurance exchange commissioner--which would really mean convincing President Obama--to open the exchange to everyone in America in 2015.
That's the decision that I think is an attempt to avoid accountability. And I don't see a reason for avoiding accountability on that decision if you are trying to do the right thing.

Ah.  My mistake.  I'm in agreement with you, then.  Obama (or whoever's President by then) should be the one accountable.  Although really, this shouldn't even be a decision.  It should just automatically happen.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.
[ Parent ]
wyden gains key support from sanders and bayh (0.00 / 0)
PLEASE SEE my quick hits post. ltr sent today to reid from wyden, boxer, sanders, bayh (yes) -libs and conservadems agree that they want exchanges more open now. wyden now has key support from all parts of the party to move fwd
Without a strong, viable public option... (0.00 / 0)
...Wdyen's "choice" bill could be a disaster for the chronically ill on better, cheaper, self-insured employer plans.

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!
[ Parent ]
Mark Matson first posted this in a QuickHit (0.00 / 0)
http://www.openleft.com/showQu...

I just saw it there!

If you want me to be optimistic (which is a pretty tall order, granted), (4.00 / 3)
at least show me that the prog bloc is still willing to kill this bill if it isn't significantly improved.  The leadership fears not passing a bill more than they fear making it better for the people (or worse for the insurance industry, depending on how you prefer to see it; the upshot is much the same thing).  That's our only advantage; our only leverage.  We have to use it if we want to get anything.  Can you show me that we're still going to use that to our advantage?

Otherwise, this is all just a bunch of pretty talk.  We can't do anything, so we might as well just sit down like good little children and enjoy the kabuki.

I'm willing to continue fighting, but I have to see that our allies in congress are committed, too.  Right now, I'm not hearing any commitment from them.  Did I miss it?

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

I saw this comment on a quickhit link to susie madrak (4.00 / 1)
please tell me this isn't true:

Here's Where the American People Are Going To Get Reamed:

    Fri, 10/30/2009 - 15:15 - Abbybwood

Medicaid.

You may think, "We'll, I don't qualify for Medicaid".

I do believe there is a very good possibility that many, many more millions of Americans will fall into Medicaid once all the dust is settled in 2013. It will all be figured according to your income from the prior year.

You may be Medicaid "eligible" and not even realize it until you are "auto-enrolled" without even knowing it. You may then be caught in a "program" where you cannot even find a doctor who will accept Medicaid's substandard reimbursement rates. You certainly will not find the same standard of physician that an individual with "private" insurance will be able to see.

Furthermore, if you happen to own your home or have any assets, you may end up losing your home if you need to tap into Medicaid for a major hospitalization etc. via the program known as "estate recovery".

This is an example of what activists in Massachusetts have been TRYING to explain to folks in the blogosphere.

http://crooksandliars.com/susi...

if someone is medicaid-eligible but not medicaid-enrolled will he get enrolled automatically? one of the medicaid rules I know is you can't have more than $2,000 in a bank. what happens if the auto-enrollment point is true and someone with say $5,000 in the bank gets auto-enrolled to medicaid?

There's a whole industry devoted to shielding assets from Medicaid (0.00 / 0)
So let's look on the bright side: The lawyers will get a lot more work.  

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 ]
In MA, when universal went into effect... (0.00 / 0)
They found lots of people eligible for Medicaid who hadn't signed up.  They signed them up and it worked out great!

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!
[ Parent ]
ok (0.00 / 0)
but what happens if you are auto-enrolled and you have a couple grand more than medicaid allows?
[ Parent ]
if I read it correctly, the asset test is eliminated (0.00 / 0)
and the test is the individual has to be under 150% of the federal povetry level

from the house bill:

SEC. 1703. CHIP AND MEDICAID MAINTENANCE OF ELIGI-
BILITY.
...
(b) MEDICAID MAINTENANCE OF EFFORT; SIMPLI- 8
FYING AND COORDINATING ELIGIBILITY RULES BE- 9
TWEEN EXCHANGE AND MEDICAID.
...
''(2) REMOVAL OF ASSET TEST FOR CERTAIN
ELIGIBILITY CATEGORIES.-
''(A) IN GENERAL.-A State is not eligible
for payment under subsection (a) for a calendar
quarter beginning on or after the first day of
Y1 (as defined in section 100(c) of the Afford-
able Health Care for America Act), if the State
applies any asset or resource test in deter-
mining (or redetermining) eligibility of any indi-
vidual on or after such first day under any of
the following:
''(i) Subclause (I), (III), (IV), (VI),
(VIII), (IX), (X), or (XI) of section
1902(a)(10)(A)(i).
''(ii) Subclause (II), (IX), (XIV) or
(XVII) of section 1902(a)(10)(A)(ii).
''(iii) Section 1931(b).
''(B) OVERRIDING CONTRARY PROVISIONS;
REFERENCES.-The provisions of this title that
prevent the waiver of an asset or resource test
described in subparagraph (A) are hereby
waived.

that will save a lot of lives

if the final bill is close to this, I can support it  

[ Parent ]
Oh goody. (4.00 / 1)
Only 5 more years without insurance.
I mean 6 years. (0.00 / 0)

[ Parent ]
Yeah, and since Truman first proposed it ... (4.00 / 1)
It's been about 62 years.  So you know what?  I'll accept six.  It beats the hell out of never ... which is what the 'kill the bill' brigade would bring us while they clap harder for 'single payer.'
[ Parent ]
Don't conflate "kill the bill" with single-payer purity. (0.00 / 0)
Kill the bill is a tactic to get a better bill.  The bill will never be perfect, no matter how much we threaten to kill it.

That said, there has to be teeth behind the threat, or it won't be taken seriously, and we won't see a better bill come of it.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
How in the world will killing the bill (4.00 / 1)
get a better bill...killing the bill will mean no one will touch the issue for another 20 years.  
[ Parent ]
Care to offer a reason (0.00 / 0)
for that gigantic assumption?

Politics is the art of the possible, but that means you have to think about changing what is possible, not that you have to accept it in perpetuity.
[ Parent ]
Because killing a bill (0.00 / 0)
will probably effect turnout next year, delivering major gains for the Republicans that Democrats are going to spent the next few election cycles trying to come back from. Anything remotely progressive would be off the table.

It's not a gigantic assumption, it's happened before. Or do you not remember the liberals who argued if we kill Clinton's healthcare plan, we can always come back to it in a few years.

and never did.

[ Parent ]
Passing a bad bill (0.00 / 0)
could also hurt turnout - as turnout is mostly about the base, and the base will be more attuned to the details than a win / loss. But both could conceivably impact turnout.

I have no idea why you think low turnout in one off year when the Democrats aren't terribly vulnerable (in terms of challengers, open seats, etc.) would have a multi-cycle impact. That is a rather novel conclusion about long term electoral dynamics.

People support many progressive policies, so if they become off the table its because over paid consultants would rather loose elections than win in a way that would empower progressives. That is not an argument for progressives supporting this bill no matter what the details.

(Some) liberals once said something about a different historical moment that turned out not to be true is not nearly the winning argument you think it is. See below.

Politics is the art of the possible, but that means you have to think about changing what is possible, not that you have to accept it in perpetuity.

[ Parent ]
History (0.00 / 0)
Perhaps you forgot the last 15 years with absolutely nothing done.

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!
[ Parent ]
I didn't forget anything (0.00 / 0)
There is no historical law that says that what happened once before will happen again in exactly the same fashion. The public was plenty willing to tackle this again. Republicans stood in the way, and Democrats made little effort to fight.  On the other hand, when Medicare was tried at first it failed, but Democrats kept trying and got it before too long.  Whether Democrats are willing to fight is the key issue, not some magical historical constant.  

Whether we have to act now or not is a tough question.  But this 20 years window argument claim is nonsense.


Politics is the art of the possible, but that means you have to think about changing what is possible, not that you have to accept it in perpetuity.

[ Parent ]
Let me use an example. (0.00 / 0)
If it's just the two of us sitting across the table from each other hashing this out, your desire to take anything so long as a bill is passed allows me to write it however I want.  I could put in tort reform and privatization of Medicare and mandates to buy insurance with government subsidies and on and on.  So long as you're not willing to kill the bill over any of it, I'm going to get what I want.

The only thing that will stop me from doing that is when you decide that what I'm putting in is so bad that you'd rather there be no bill at all.  Only then is there a possibility for you to get anything you want out of it.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
public option (4.00 / 2)
I don't know if you'd call this optimism or pessimism, but I actually think that the economic situation in this country is going to become so dire that a radically different and more progressive healthcare system may arise out of sheer necessity.  What's going on with the present bill is a lot of tweaking and fiddling at the edges, but it isn't going to fundamentally alter the healthcare landscape.  The same big, predatory players are still going to dominate.  Ultimately, we are going to need to scrap everything and start fresh.  This isn't to minimize the efforts that many are making to improve the present circumstances, because a lot of good people are trying their best.  I just don't think that it's bold enough.
Hope You're Right (0.00 / 0)
I also think that the economic situation will get much worse, but I don't see how that will serve to improve healthcare for all.  In fact, I think it will end up being blamed on Obama's  policies and it's going to let the opposition party get back in play.

What will be interesting is watching NY-23 and trying to figure out what's happening to the Republican party.  My suspicion is that the wingnuts will prevail over the moderate Republicans  (although the split may allow the Dem to win}.

[ Parent ]
predatory players (0.00 / 0)
The same big, predatory players are still going to dominate.

with the mandates, the current bill looks to put the predatory players in a much stronger position.

we don't have  to say, "kill the bill." just, "kill the mandate."

i really don't understand why progressives haven't raised holy hell about the mandate before now. what's the purpose of making one's enemies stronger?

[ Parent ]
"Kill the bill" is a tactic. "Kill the mandate" is a goal. (0.00 / 0)
Tactics and goals are not interchangeable.  You use tactics to achieve goals.

That said, I don't think killing the mandate is an achievable goal at this juncture.  For one thing, since we're not going with single-payer, a PO is going to need to mandate people have coverage in order for it to be successful.  Otherwise you end up with too many healthy people choosing to not have coverage, which distorts the healthy:sick ratio in the risk pool, causing the plan to fail.  (This was one of the big reasons there was such a ruckus over getting the Medicare +5 version in the house.  It would have lowered premiums, making mandates more palatable to everyone.)

For another thing, it's too late.  It's in both bills, now.  If it were in one bill but not the other, there might be a chance in hell.  But at this late date, the only thing that would have a chance of making it happen would be if enough Senators or Representatives wanted to band together and make it their cause.  In other words, they'd have to be willing to kill the bill over it.  (Ironic, no?)  For good or ill, I don't see that happening.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
mandate (0.00 / 0)
it's a crappy po that doesn't justify a mandate.
[ Parent ]
It's a crappy PO, period. (4.00 / 1)
No one's been able to prove otherwise.  Yet here we are.  A prog bloc that won't hold the line, and half the left willing to go forward despite the promise to kill the bill.  What can we do?  We haven't the power ourselves to stop the madness.

Fight.  In this battle, the keyboard is our weapon.  Arm yourself with facts and wield them with all the rhetorical skill and polemic power you have.  Do your best and never give up.

(Sorry.  Was trying for philosophical and instead got all mawkish or maudlin or something like that.  I'll try to avoid doing that in the future.)

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
2009 NOT hacker's original vision... that would be the 2007 proposal (4.00 / 1)
...something very close to Jacob Hacker's original vision of the public option.

chris, the april 2009 link you give is NOT hacker's original vision. take a look at his 2007 paper (and what he was talking about through the summer of 2008) the 2007 proposal was what the lewin group reported on and that is what CAF lauded. and that was what was sold to progressives in the summer of 2008.

holy cow, you never read kip sullivan's bait and switch posting, did you? if you had, you would know a lot of this. and very importantly, you would know that it was not about you or cpc. no wonder you were so pissed off, if you thought that. but it's just not so.

http://www.sharedprosperity.or...
http://www.sharedprosperity.or...
http://pnhp.org/blog/2009/07/2...

missing criteria for original vision of a public option (0.00 / 0)
it is actually still possible that we can pull off the original vision of a public option

nope. you are missing some critical pieces. from kip sullivan's post:

Hacker's papers laid out these five criteria that he and the Lewin Group said were critical to the success of the "public option":

• The PO had to be pre-populated with tens of millions of people, that is, it had to begin like Medicare did representing a large pool of people the day it commenced operations (Hacker proposed shifting all or most uninsured people as well as Medicaid and SCHIP enrollees into his public program);
• Subsidies to individuals to buy insurance would be substantial, and only PO enrollees could get subsidies (people who chose to buy insurance from insurance companies could not get subsidies);
• The PO and its subsidies had to be available to all nonelderly Americans (not just the uninsured and employees of small employers);
• The PO had to be given authority to use Medicare's provider reimbursement rates; and
• The insurance industry had to be required to offer the same minimum level of benefits the PO had to offer.


[ Parent ]
Reasons for Public Option Optimism | 53 comments
USER MENU

Open Left Campaigns

SEARCH

   

Advanced Search

QUICK HITS
STATE BLOGS

Home | RSS/XML Feed | Register | Contact

  © OpenLeft 2007-2010, Powered by SoapBlox

Powered by: SoapBlox