Changing the goalposts on healthcare reform

by: Chris Bowers

Wed Dec 02, 2009 at 15:55

As the Senate health care debate slowly drags on, I still support the Senate health care bill, and would still consider passing it to be a progressive victory.

Yesterday, in response to my claim that passing the bill would be a victory, Gabriel D rightly noted that in calling the Senate health care bill a victory, I have redefined my position on what victory means for this legislation:

Way to redraw the line, Chris.

Never mind that the bill is no longer progressive.  Never mind that it does more to prop up and calcify the health insurance industry.  Now the question is, can we get even a few breadcrumbs?  Really?

No, Chris.  That's a dumb way to look at it.  There is very little if anything progressive about this legislation, and rather than defending it, we should be attacking it from the left.

I am not going to defend myself by claiming that I have been consistent during this entire process.  I admit that I have changed during this debate.  Since I will be making more asks for the Open Left community to take action in support of health care legislation, I wanted to let you know why I had changed.  As members of the Open Left community, you deserve nothing less.

Explanation in the extended entry.

Chris Bowers :: Changing the goalposts on healthcare reform
In the past, I had previously defined success as increasing the power of the Progressive Block and passing a nationally-available public option tied to Medicare rates.  My thinking on the matter started to change when Representative Alan Grayson started talking about the number of people who die each year from health insurance.   Even though I, and other members of my family, had gone through sometimes lengthy periods without health insurance, it was still not an angle I had considered previously.  Saving those lives is a very powerful, ethical argument to me.

Granted, it is not entirely clear how many people die each year because they lack health insurance.  Different studies have suggested 18,000, 45,000), or an unknownable number anywhere from zero to 36,000.  Still, the varying studies make it highly likely that at least several thousand people die each year from a lack of health insurance.  With that in mind, the Senate bill reduces the number of people uninsured in this country by roughly two-thirds, which will save two-thirds of those at least several thousand lives.  The House bill will reduce the number of uninsured by roughly 75%, thus saving three-fourths of those at least several thousand lives.

Funneling huge amounts of customers and public money to for-profit health insurance companies is offensive to me ideologically.  The continued lack of influence Congressional Progressives have over public policy is also extremely frustrating.  However, thousands of people dying because they can't afford any health insurance at all is much worse than both of those negative outcomes combined.  I don't think I could tell anyone who can't afford any health insurance that I would prefer they not have any insurance at all than have subsidized insurance from a for-profit company.  Further, I don't think I could tell anyone who can't afford health insurance that I would prefer they not have any insurance at all than for the Progressive Caucus to remain relatively less-influential than the Blue Dogs.  When faced with a choice between the status-quo, and providing subsidies to make it easier for low-income people to purchase private health insurance, I choose the subsidies.

On average, by the middle of the next decade, the House and Senate bills will use about 0.5% of the national GDP to subsidize low-income people purchasing health insurance, and place about 0.2% of GDP into a new public health insurance option.  While neither of those victories are assured, and while neither of those victories are anywhere as large as could have been, they are still two of the only long-term expansions of the social safety net in decades.  And, as such, they are still progressive victories--perhaps even large victories, given how rare any progressive victories have become.

There are still important remaining questions about reproductive rights and the ultimate fate of the public option, but in broad strokes this is where I stand.  I know not everyone is going to agree, but not everyone agreed with the Progressive Block, either. Our community is neither static nor homogeneous, and it never will be.

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Sorry Chris. (4.00 / 2)
45,000 people die in Highway accidents every year too.

This bill is worse than nothing.

A 20% Corporate Welfare Tax on every American except the richest and repeal of Roe v. Wade for the privilige.

Make whatever mental excuses for your sell out you need to.  Wouldn't want you to have trouble looking in the mirror in the morning.

And here's another edition of 'what digby said' for you too- (4.00 / 4)
Ezra believes that if the votes aren't there for a decent public option then the horse trading should be around getting something good in return for giving up the public option rather than negotiating the terms of the public option. That would make sense if the public option were just another feature of the health care bill. But it is not. It is the central demand of the liberal base of the Democratic Party in this rube goldberg health care plan and has long since gone way beyond a policy to become a symbol.

Perhaps that is wrong on policy grounds. People will argue about that forever. But that doesn't change the fact that it is no longer a matter of policy but rather a matter of political power. And to that extent it cannot be "bargained away" for something like better subsidies, even if it made sense. "Bargaining away" the Public Option is also the bargaining away of liberal influence and strength.

Indeed, since the political establishment and the media has been declaring it dead for the past six months, the fact that it is still in the bill is a testament to liberal strength. And that is why Republicans and corporate centrists are so desperate to destroy anything that's called a "Public Option" no matter how many compromises are made to acomodate them. And it's why the liberals are so adamant about keeping it alive.

Again, as a matter of policy I don't know that the public option actually means much anymore. But as a matter of politics, it's very important. Powerful people, from outside and inside the Party are desperate that the liberals are not seen to win this battle. It changes the balance of power in ways that extend far beyond the health care debate and they know it.


[ Parent ]
Which directly goes into the ability (4.00 / 3)
to fight in the future should a fight come up regarding cutting the subsidies, but leaving the mandates. As I have written in his diaries, the problem with progressives is not their numbers. It is their lack of negotiation skill.  

[ Parent ]
This bill is a HUGE gain (4.00 / 3)
It will reduce annual premiums for a family of four making 60K a year (more than the median) from $9,980 to $5,240. Is avoiding an imperfect bill so important you'll stick the average American family with a $4,780 annual bill to avoid it?

Never mind that the bill also end recission, so if somebody pays for health insurance, at least they'll get it.

[ Parent ]
why is someone rating my response to this comment (4.00 / 1)
a zero?  

[ Parent ]
Why do you say it is b.s.? (0.00 / 0)
The comment linked to a Krugman blog post. Do you not trust Paul Krugman?

Save Our Schools! March & National Call to Action, July 28-31, 2011 in Washington, DC: http://www.saveourschoolsmarch...

[ Parent ]
because you are hiding cost rather than saving money (4.00 / 1)

[ Parent ]
Partially hiding, but not entirely (0.00 / 0)
The US healthcare system is insanely inefficient. The paperwork of the providers trying to screw over the insurers and the insurers screwing over the providers and BOTH screwing over the public consumes perhaps 20% of healthcare costs. Another 10% is wasted via delayed care. The Senate bill helps with both of those, which creates a lot of real gains. From the CBO report - and I do consider them reasonably competent and honest - the gains are large enough for a big cut in rates to the public and big increases to insurance profits at the same time. I'm surprised the gains are that large and shared that well, but apparently they are.

Also - the Senate bill is using passably progressive taxes (on elective surgery and generous care plans) to pay subsidies for the poor and middle class. That is, actually, a good thing, even without efficiency gains. That benefit would probably improve in conference with the House's millionaire tax.

[ Parent ]
Yeah right. (0.00 / 0)
Tax Union benefits.

That's sure 'progressive'.

And the Senate Bill does NOTHING to fix the paperwork costs.

It leaves the SAME people doing the SAME things in place.

[ Parent ]
Rated up for troll rate abuse (0.00 / 0)
Please stop it.

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 ]
what do highway accidents have to do with this? (4.00 / 3)
That is some kind of logical leap:

-- 45,000 people die in highway accidents


--Saving 30,000 lives by providing health insurance doesn't matter.

That simply doesn't make any sense

[ Parent ]
We should therefore outlaw cars. (0.00 / 0)
It makes as much sense as your argument.

[ Parent ]
Yeah, that makes sense (0.00 / 0)
Really, saving 30,000 lives by providing health insurance is the same as outlawing cars.


[ Parent ]
And saving 30,000 lives... (0.00 / 0)
means we should give Insurance Companies Hundreds of Billions and repeal Roe v. Wade.

Like I said, exactly as much sense.

Also exactly as much sense as gutting the Constitution and Bill of Rights and killing 5,000 troops and hundreds of thousands of innocent brown because 3,000 died.

People die all the time.

What's more Chris, your compromise doesn't do ONE SINGLE THING to prevent those 30,000 deaths from continuing.

It doesn't provide a dime of Health Care or prevent any of the bad practices of the Insurance Companies.

It is a big nothing.

No Public Option == No Mandate.

[ Parent ]
My mother passed away in part because (4.00 / 10)
she did not have insurance, and thus, they were not able to detect the disease early enough to treat it. Moreover, after, they did detect it, the treatment was still slow in coming and I spent most of a year taking care of it. This is to say I am in better position that you to discuss what a lack of health insurance means. I also in a better position than you to discuss poverty and what it means.

The result was that it significantly lowered her chance of survival that she would have had if they detected the disease early enough. So, this is all rather personal to me, and I find your views to be wrong. I live in a poor working class black neighborhood although economically I am not.  Guess who will chiefly be impacted by all of this?

There is no reason for a mandate if you are not going to have cost control. That's the value to us. If it is too expensive, we won't buy it. It is that simple. A subsidy only matters for a short period of time, or until the next assault on entitlements by the government.  

You  can address all of the issues you mention without a mandate. You can still have subsidies without it if you want to increase coverage without addressing cost. What you should not do is to force people to buy expensive plans. What you should not do is to penalize them if they don't. The only rational for mandates is cost containment. So, end the mandates, and then, I will not care what's in the Senate bill.  

Aren't mandates needed for guaranteed issue? (4.00 / 1)
Don't mandates go hand-in-hand with the prohibition of denial for pre-existing conditions? Otherwise wouldn't people wait until they need insurance to buy, since they couldn't be denied when they applied.  

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
Guaranteed healthcare not guaranteed issue. (4.00 / 4)
What's the use of being offered insurance you can't afford? What's the use of buying insurance you can't afford to use? The mandate is the law: You WILL buy the private insurance product or pay a stiff fine. The guarantee is squishy. It's not an even trade.

[ Parent ]
The only reason that matters is that you are worried about cost containment (4.00 / 3)
If you are not worried about cost containment to consumers (which Chris, the White House and the Senate clearly are not), then, it does not matter.

The question is who should bare the risk here? Insurance companies that are going to make record profits under this bill from a captured market or individual consumers through mandates?

The insurance companies are in a better position to take on the risk. Even with subsidies, individual consumers are not. Getting rid of the mandate forces the insurance companies to find other ways to obtain profit than a captured market.  

[ Parent ]
remember also (4.00 / 3)
   we are discussing what in many  states are oligopolies. This means a lot with regarding pricing:

"An oligopoly ... is a market form in which a market or industry is dominated by a small number of sellers (oligopolists). The word is derived, by analogy with "monopoly", from the Greek oligoi 'few' and poleein 'to sell'. Because there are few sellers, each oligopolist is likely to be aware of the actions of the others. The decisions of one firm influence, and are influenced by, the decisions of other firms. Strategic planning by oligopolists needs to take into account the likely responses of the other market participants. This causes oligopolistic markets and industries to be a high risk for collusion."

I would rather in such  situation place the pressure on the oligopoly than the captured consumer. That's why what Chris describes is regressive if mandates are included.  

[ Parent ]
Missing my point... (4.00 / 1)
...Which had nothing to do with cost containment or industry profits or oligopolies. My point is really much more fundamental -- if insurance companies are required to accept all applicants, at any time, regardless of pre-existing conditions and provide coverage for pre-existing conditions, why would anyone buy insurance before they needed it?

The point is simple -- removing pre-existing exclusions and requiring insurers to take all applicants at any time creates an affirmative incentive to not buy insurance until needed. It's an entirely unworkable model.

...Adding, people focus on mandates as a way to bring young "healthy" people into the pool for cost containment (really actuarial risk spreading, not cost containment). But consider someone outside that category -- I'm in my early 50's, generally healthy, slightly overweight and have high blood pressure corrected to normal with one generic drug costing less than $10/month retail. Why would I continue to pay $500+ a month for insurance if I could just wait until I needed it and be guaranteed acceptance when I need it? Implement guaranteed issue and they'll need a mandate to keep me.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
I did not miss your point. I am thinking down the road in a different way (4.00 / 1)
than simply repeating the dominant arguments.

You say my argument is unworkable. Unworkable to whom?  To you? How is that possible since they are banned from denying you coverage?

To insurance companies?  If so, - Good.  They should bare that risk- which is at the heart of what we are discussing. Who should bare the risk and why.

If they bare the risk, then they will have to change their model to attract you before rather than after you are sick.

[ Parent ]
Under your plan... (4.00 / 2)
...there will be no more insurance companies. They would all go out of business. Nor could the government come in and replace them. The model would be just as unworkable for the government, because the only people paying in would be people needing care (money back out).

One more point -- insurance companies don't bear risk, they spread risk using large pools of insured people. Under your plan there wouldn't be enough people in the pool. The entire model falls apart.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
Reality check (4.00 / 1)
a) Free riders already exist.  We are discussing whether the government will pay for them or insurance companies.

b) Your argument over risk pools is nonsensical.  

[ Parent ]
Please explain why (0.00 / 0)
b) Your argument over risk pools is nonsensical.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
Good. (0.00 / 0)
They are nothing but leeches.

And if not Single Payer, Public Option, or Strong Regulation how do you justify giving them 20% of every single American's income?

No Public Option == No Mandate.

[ Parent ]
I agree that if insurance companies are (4.00 / 2)
going to get individual mandates to make us buy their overpriced insurance, then we should get something in return.  I just don't think that merely doing away with pre-existing conditions and recision is enough.  

Mandates merely enhance their near-monopoly grip on healthcare, and we need more to hold down rates.

I believe that the only fair trade for mandates is a robust public option available immediately, no triggers or opt outs, and rates tied to Medicare.

And I believe that if Democrats pass a bill without a robust public option, the public will soon enough realize that we've been screwed, and that will be the end of the Democratic Party for another 30 years.  

They won't be able to just say:  "Well, it's the best that those nasty Republicans would let us do!"  And remember, there won't be a single Republican vote on this thing.  We will own it.

I'm in my fifties, and keeping even crummy health insurance for my family of four is driving me toward poverty in this economy.  I had hoped that I might get a better deal for those last few years before I'm eligible for Medicare....

Even with out mandates, the insurance companies are saying to me:  "Nice kid you got there.  'Be a shame if something happened to her..."

[ Parent ]
It's not give and get (0.00 / 0)
I can't stress this enough -- It's not a negotiation or exchange, where we 'give' the insurers mandates and in exchange they 'give' us guaranteed issue. The simple fact is you cannot eliminate the pre-existing conditions exclusion without mandates. The two are bound together. Otherwise you and I and everyone else would avoid paying for insurance until our health fails and we actually need it. The entire model of broad-based insurance risk sharing would disintegrate because only those who are drawing out would be paying in.

As to your other points, I generally agree, particularly w/r/t public acceptance of the overall plan if it's entirely based on private insurance. But you can't use mandates as a bargaining chip to get a public option. Eliminate mandates and you lose the pre-existing conditions/recessions changes, and the entire HCR framework falls apart.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
agreed (4.00 / 1)
It seems many people on this thread are basing their ideas on heath care simply on rage at the insurance companies. The rage is justified, but it's still a terrible basis for legislation.

The point is to help more people get more of the medical treatments they need, not just punish the insurance companies for being bad corporations.

[ Parent ]
Expat who lives in Australia does not buy pre-exist argument (0.00 / 0)
We have Universal Health Care as a base, and then a private insurance industry on top of that here, that essentially lets you pay for "instant care" and a lot of things like getting tattoo's removed, etc..., that the public system makes you wait for treatment for.

And the way the government dealt with pre-existing conditions was to allow the insurance industry to put in a delay cause on pre-existing conditions of 12 months.

You don't have private insurance, then realize you have a pre-existing condition you want covered, fine, but you have to wait a year to get it covered. Yes, many people do join up, then wait the year to get treatment if they really want it, , but often, due to the delay clause, many people don't bother. It works, since if you have any serious or any real "life threatening" issues, they are already covered in the public system.

My mother in law needed major hip surgery, all surgery, instant care, all covered by public plan at no cost whatsoever. Heck, a visitor over from America just rocked up to a doctor here, got diagnosed, got meds, total cost $124 out of pocket, same issue in America, at least $2000 plus.

So the pre-existing argument is just so much bs...

[ Parent ]
No comparison to our situation (0.00 / 0)
If you already have universal coverage then everyone is already covered and everyone is already paying via taxes. And that's 'mandated' as a responsibility of citizenship. Elective, supplemental coverage is just that. It's really not fair to compare that to our situation about primary private insurance.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
at what cost do we defeat the subsidies? (0.00 / 0)
So, we should defeat 50-100 billion a year in health care subsidies because of the mandate?

Again, I don't see that as a trade off I can sell.

Also, given that you think I don't care about cost control, please explain to me how defeating this bill will control costs.

[ Parent ]
my point is horse trading (4.00 / 1)
why exactly do we have to accept mandates to get the subsidies. The lack of negotiation is amazing.  You do not care about cost containment because of your stated position. That positions means you have made certain choices about what to prioritize. I care about a lot of things. My priorities tell others about what is crucial to me. I did not say defeat this bill. I said that if you are going to take cost control off the table, then you need to take out the mandates. It is again called horse trading. If they get something, so do you.

[ Parent ]
by the way (4.00 / 2)
without an real cost containment element, there will be no way to control cost whether this bill exists or not. That's exactly the point you seem to be missing, and as for the subsidies, unless they are increased over time, they will not help as much as you think with that cost. This does not even include the junk insurance issue.  

[ Parent ]
I forgot to include some info on the cost containment issue for others to read (4.00 / 2)
"The legislators' reluctance to control premium costs comes despite the fact that they intend to require virtually all Americans to get health insurance, an unprecedented mandate -- long sought by insurance companies -- that would mark the first time the federal government has compelled consumers to buy a single industry's product, effectively creating a captive market." nation/la-na-healthcare-affordability2.a r1-2009sep24,0,3253631.story

The article continues:

"We are about to force at least 30 million people into an insurance market where the sharks are circling," said California Lt. Gov. John Garamendi, a Democrat who served as the state's insurance commissioner for eight years. "Without effective protections, they will be eaten alive."

Also attempted to discuss it here, but have not looked at any research on the more recent proposals:

[ Parent ]
At what cost?! (0.00 / 0)
The subsidies go directly to the Insurance Companies!

They don't go for Health Care at all!

It's just 50 - 100 Billion in Corporate Welfare you're talking about.


[ Parent ]
Your argument (4.00 / 1)

Yes, it does.

Your argument is that people without any health insurance are getting as good health care as people who have purchased health insurance from a for-profit company.

That's simply not true.

People without health insurance are worse off than people who have purchased health insurance from a for-profit company.

[ Parent ]
it depends on if it is junk insurance or not (4.00 / 1)

[ Parent ]
Exactly. (0.00 / 0)
60% benefits Chris, 40% out of pocket for 20% of your income (which goes to the Insurance Company Chris, not Health Care)-  the Senate Bill is JUNK.

And yes they are getting just as good care, better in most instances in my experience.

[ Parent ]
That's not true (4.00 / 1)
As a self-employed worker, I've had junk insurance and I know how bad it can be. But no insurance at all is even worse. Some emergency rooms won't even take you.

Save Our Schools! March & National Call to Action, July 28-31, 2011 in Washington, DC: http://www.saveourschoolsmarch...

[ Parent ]
I am not even sure how to respond to this (4.00 / 2)
Junk insurance is a sophisticated way of saying you can't pay your bill through your insurance coverage. Do you think people are going want to take your coverage if they know this? I guess we are about to find out. On the flip side, if you want to see why your statement is false- check out who is showing up to health care fairs. It is not just people without insurance. It is mostly people with not enough insurance.  

[ Parent ]
I completely agree (0.00 / 0)
I just wanted to say that there's not a simple either-or choice here, which is somewhat Chris's point as well. For instance, when I had no insurance whatsoever, I had to pay full fare every time I went to a doctor. When I had the most meager insurance coverage provided in my state, I at least became part of a preferred group that cut 30% off doctor bills and payed 80% of some procedures. That's better than nothing. If the Senate HCR bill makes it possible for millions of people to get better access to healthcare because they have insurance coverage, then that's an improvement to the status quo with millions having no coverage at all. I agree that I wish we had better choices than the Senate bill. And mandates could stick lots of young, healthy people with unfair payments on low-quality insurance unless we insist on there being generous government financial assistance and strict regulations on quality in the bill. But I think voting it down and starting all over would be a big mistake.

Save Our Schools! March & National Call to Action, July 28-31, 2011 in Washington, DC: http://www.saveourschoolsmarch...

[ Parent ]
The problem on this front are several fold (0.00 / 0)
a) it is not enough insurance b) it gives the illusion that something has been done to reform health care c) it is mandated junk insurance rather than optional  (if the benefit of the bargain were greater, then fine, but it's not- and that's why I find chris's statement exceptional. the peo he claims to want to help will barely, if at all, be helped. we are speculating that they will, but given the bill, this is not even close to a certainty. Meanwhile we burden them with mandates and an insurance policy that will become increasingly more expensive with subsidies that will not protect them from those cost increases sufficiently). that's what find unacceptable. The choice is not voting down. THe choice is taking out the mandate. THe false frame is what I have a problem with here too. At this point I have said this sufficient number of times to assume that people are just not reading what I am writing.  

[ Parent ]
Your point about the mandate is very well stated (0.00 / 0)
and I'd forgotten that that was the main thrust of your argument. The junk insurance I bought in my state should have not been sold, and indeed is no longer on the market at least from the purveyors who I purchased from. That's why I think strict government regulation on what is allowed in these exchanges is really the key. And if that isn't part of the final bill, then you're right, a mandate would just be an opportunity for big insurance to sell lousy plans that are partially subsidized by tax payers.

Save Our Schools! March & National Call to Action, July 28-31, 2011 in Washington, DC: http://www.saveourschoolsmarch...

[ Parent ]
junk insurance is what is on the table right now (0.00 / 0)
This is the one-two that bothers me about Chris's post. I thought that was understood. Hell, even the argument over pre-existing conditions ignores that the premiums will be so high as to unaffordable.  

[ Parent ]
in the version of the senate bill originally released (0.00 / 0)
e.g. there are mandates on what percentage of premiums insurance  ompanies can spend on non-care related issues.  presumably they will cheat.  but it still is in there, which is good.

[ Parent ]
Saving lives good. (4.00 / 5)
But will it make premiums higher for everyone else? If coverage is mandatory and subsidized, won't insurance companies just raise their rates through the roof and laugh all the way to the bank?

And doesn't this play right into conservative hands by subsidizing the poor at the expense of the middle class? If this is to be a political "win," it has to benefit the middle class too by limiting premiums.

I am not saying that I am at the point of opposing the bill. But the less willing we are to risk passing nothing, the shittier the end product will be.

Premiums will be substantially lower (4.00 / 2)
For anybody but the rich (who will still get a slight reduction).

CBO analysis

[ Parent ]
again b.s. (4.00 / 1)
they are not really lower. it just covers up the fact of the cost increases.  the end result is delaying the real potential for collapse.

[ Parent ]
That's with a public option, right? (0.00 / 0)
What if the public option doesn't make it into the final bill? My point is that lowering premiums for most people should be a make or break for progressive support.

[ Parent ]
People die (0.00 / 0)
can't stop that.

People will continue to die, even if the bill you support is passed into law.

Will we see an actual accounting of the deaths after this bill goes into effect, so that we all can see how many lives were actually saved?

All that aside, thanks for making your position clear. You're responsible for your actions, that's a rare thing, unfortunately.

"It sounds wrong...
     ...but its right."

fewer people will die (4.00 / 3)
Fewer people will die.

If people are dying because they lack insurance, and this bill will cover tens of millions, then it will save a lot of lives.

Unless you don't think people die from lack of insurance. To convince me it isn't worth passing, you need to tell me how passing it will cause something worse than the lives it will save.

[ Parent ]
It's not so simple as "life good, death bad" (4.00 / 1)
Life at what cost?  If we could save a million lives a year by abolishing the Bill of Rights and instituting a dictatorship, would that be worth it to you?

Granted, an individual mandate to buy private, for-profit health insurance isn't anywhere near that extreme.  But if businesses are allowed to continue their destructive practices and raise their rates without impunity, at the expense of the people and the government, there'll come a point when it won't be worth all the extra lives we're supposedly saving.

[ Parent ]
it will also cause people to die (4.00 / 2)
because it will leave insurance in the hands of insurance companies, who will seek opportunities to cut care, absent government intervention, which won't always happen.  and it will happen by a market mechanism, which means the people least able to afford this will be the ones who will be subjected to poor care, denial of services, etc.

i'm not saying it won't make anything better - it probably will - but i think the issue is more complex than you're laying out.  my father died in part because the insurance company woudln't let him go to the hospital his cardiologist was at - how would this bill help people like him?

if you want to stop people from dying, immediately, campaign against the wars, don't focus your energy on health insurance, which is a massive system that invovles costs and benefits and under any given scenario will result in some people dying.  And focus on increasing the voices of people at the bottom whose interests you are trying to protect so that they, rather than you, can make th necessary difficult choices.

[ Parent ]
and you have to provide some analysis for why 'fewer' people will die (4.00 / 1)
with any reform that is even remotely positive, 'fewer' people will die.  that is the point of progressive politics.  but is it the right way to move forward so that the best possible path for people now and tomorrow.  Emphasis on 'possible' - pie in the sky criticisms are useful for framing but not for evaluating specific policies at a given time unless they're profoundly flawed.

[ Parent ]
No argument that people die from lack of insurance (4.00 / 1)
But people with insurance die too, some because the insurer puts profits before healthcare. As far as I can see, there is little in the current bill to reduce the profit motive, so insurers will still be denying claims, and jetting off to vacation with their bonus for increasing the bottom line.

So the calculation is not as simple as you suggest.

The "lives saved" approach also needs a consistent time line. How long will you compare death rates?

For example: Can we calculate the death differential between taking the incremental approach of "first this bill, then improvement until single payer emerges" and between "vote no on this bill and push single payer in the next round"? Which pathway to single payer will save more lives in the interim? The general concensus is that if no bill passes now, it will be 20 yrs until the next shot, how long until the current bill can be tweaked to look more like single payer? 5 yrs 20? 40?

So many lives, so little time.

"It sounds wrong...
     ...but its right."

[ Parent ]
can we stop saying 'I consider passing the current bill a victory' even if it is a victory? (4.00 / 2)
Am I paranoid here or does saying this open ourselves to further compromise? and do we want to let lieberman & co. to know that 'I consider passing the current bill a victory'? maybe lieberman doesn't care what we think, but a lot of you have told me the bastard doesn't want us to be satisfied.

Yes it does (0.00 / 0)
It is the mindset of losers. Well if I do this, they will accept me. More likely, they will demand even more.

[ Parent ]
I Agree with you Chris. (4.00 / 1)
However, I would add that although not as important as saving lives, providing health care for millions of uninsured will also save immeasureable PAIN and SUFFERING from acute and often chronic pain.  There are hundreds of thousands if not millions of people who have chronic pain, from things like diabetes, knee and back pain, arthritis, cancer, not to mention depression and other mental health issues, many of whom could have that pain drastically reduced, if not removed with decent health care.  

Yes, life is extremely valuable, but so is pain, suffering, and human dignity.  Don't forget those benefits.

I want health care to pass too (4.00 / 1)
...for exactly the reason stated--it will save lives.

But I'm not going to campaign for that goal, because that work wouldn't pass opportunity cost analysis.  One could save more lives by spending the time working for a wage and paying your wages to the right charity.  Politics, at least for the ordinary person, is almost never the optimal vehicle for one's energies if your goal is to save lives or even just improve your own life.  

This bill needs serious revision before we can call it health care. (4.00 / 2)
This is a hand out to insurance companies who are already raising rates. This is not health care reform. The Stupak ammendment which is going to seriously affect women's health rights may be taken out of the Senate but Nancy Pelosi says she cannot pass the House bill without it.  Lets start over and get real change we can believe in.

i admire your transparency and forthrightness (4.00 / 6)
and that's the first and last thing i'm going to say.  It's rare, and it's honest and it's smart.  Thank you for showing that respect.

I don't think I could tell anyone who can't afford any health insurance that I would prefer they not have any insurance at all than have subsidized insurance from a for-profit company.

This is analogous to arguments made in solidarity realms - e.g. the Iraq War is necessary because women and children will die if we don't engage in it; trade and environmental standards should be unilaterally imposed by the United States or American society because otherwise people will suffer; whatever shitty immigration bill the Bush/Republican Congress was going to pass was worthwhile because it would have addressed some real suffering.

There is nothing wrong with the ethics of these arguments per se, but what is wrong with them is that they don't question WHO is making the decision and why they are in a position to do so.  Similarly, here, I would ask, why are some of us in the position to decide what is in the best interests of other people (in this case people who have no health insurance).  What is missing is exactly what is most necessary- a mechanism to tell us - and more relevantly, our politicians - what some of the people most affected by an issue want.  Otherwise, it is a) undemocratic b) an irrational process and c) makes us subject to moral blackmail (e.g. consider - if there was a bill to provide health care to one person dying but it was part of a broader bill to completely privatise medicare, would you support it?)

I'm not saying your argument is irrelevant - on the contrary - it is SO relevant that, again, I think the most effective way is to pursue social democracy - which means actual, practical mechanisms and sets of mechanisms for making sure that the people who are affected by issues are the ones who are influencing how the policies that affect them are shaped.  This is the logical culmination of progressive policies - stopping short of it is essentially an argument to hold on to one's own power to take or give life (or other things) to someone else and that is inherently unprogressive.  So ultimately, it is people who don't have health insurance and bad insurance and are mistreated by insruance who need to be mobilised and organised to present a voice that is democratic and has more legitimacy (e.g. the comment above is a good example of one such voice - now multiply by tens of millions).

I hope that makes sense - I can elaborate if it doesn't - but essentially the FORM of progressive politics has to match its ideological aims and vice versa- otherwise, what actually justifieas those ideological aims?  Simple beneficence on the part of people more powerful than other people?  That sounds like (and I would argue, is) a recipe for disaster...and mass unfairness and death.

however, like i said, i am going to conclude by thanking you, again, for your transparency and forthrightness.  it is RARE to meet people in a position of even a little power who voluntarily make themselves accountable and I thank you for it.  It restores some faith that politics can work.

Healthcare not health insurance. (4.00 / 4)
Most of the people who die because of lack of insurance will still not have coverage they can afford to use. The reason is the bill does nothing to control costs, apart from a huge new tax on middle class benefits which is like taxing groceries to fight obesity. (Yeah it might help, but a lot of hungry families are going to starve in the process.) Plus, Carper pretty much said today that there are not enough Democrat votes for the public option and they will move to kill it next week. So supporting the Senate bill as it stands now is probably not going to be a choice. People complain that there hasn't been a major progressive victory in decades, but that ignores victories at the state level including paid family leave. Those programs have given more people more help than Obamacare ever will.

Thank you for helping me. (0.00 / 0)
I too had wondered why people would die for lack of health insurance instead of health care.

I believe that Obamacare if it never passes into law, will at least start the conversation to a better health care system.  

Conservative......CNN news:Nopenhagen: US PRES 2 WKS LATE ATTEND 1 DAY, GORE JOURNEY BY TRAIN.

[ Parent ]
I am an unemployed 61-year-old diabetic with bad knees and no insurance (4.00 / 5)
And my wife is unemployed with a thyroid condition and no insurance. We cannot afford the necessary blood tests that insurance used to pay for.  We are not crazed, starry-eyed idealists.  The lack of decent health care threatens both our very lives.  But neither of us can support this bill.

By what Chris has laid out, he would support ANY bill that saved one life.  But how many die in how many ways because progressives cannot get their shit together.

For instance, how many Afghan people will die because of Obama's new surge?  Won't this be a result of progressive impotence?

Chris is trying to frame this as saving lives versus abstract progressive principle, how humane of him.  But our political impotence is costing millions of lives, from war, from poverty, from sickness insured or otherwise.

Political principle isn't a game.  Its lack costs lives as well.  The bottom line is that Chris is using people like us to maintain his good standing in the Democratic club.  His waving the "saving lives" crap is cheap sentimentalism and, if you want to get serious, it isn't saving lives.

Ours are on the line and we are saying no.

Full Court Press!

Here's an answer sir. (0.00 / 0)
If you are 61, you will have 4 more years to become elgible for medicare.  You will be able to apply for SSI next year and you haven't said yet wheather you have applied for SSD (Disability)  If you qualify for SSD, you will have several options for receiving medical care help for the bills.

Any clinic receiving public funds will probably have the information necessary to help with the above.  The next step for you is to proceed to visit with a certified credit counselor for some help.  This is free and can be had through members of the National Foundation for Credit Counseling.  They can help you formulate a plan for dealing with your forthcoming bills.  (Its free!)  You need to tell them of your circumstances.  Lastly, many clinics dealing with kidney dilaysis have qualified social workers that know just about every ins and outs of the medical profession and where to get help.  Many community health organizations are supplemented with grants from the Federal Govt.  They can help guide you and refer you to help.

Yes, we don't need this bill.  The help is there for those that will want to help themselves.

Conservative......CNN news:Nopenhagen: US PRES 2 WKS LATE ATTEND 1 DAY, GORE JOURNEY BY TRAIN.

[ Parent ]
I was not asking for credit counseling (4.00 / 1)
My mental faculties are still functioning.

My point concerned the health care bill, and Chris's exploiting the plight of the unfortunate to ram it down our throats.

Full Court Press!

[ Parent ]
My point (0.00 / 0)
Your illustration uses an affordability argument about the necessary tests for health care.  Some how your problem immediately jumps to inadequate health care.  Not insurance.  

I was reinforcing your opinion of the necessity of this "health care" legislation.  I was pointing out various options, perhaps helping those that read these posts?  You can have a plan for getting the health care with the most marginal of costs because of several safety nets that are already present.  (Abrogating again the  necessity of health care legislation)

The financial portion of getting health care paid for can be assisted by the advice of credit counselors, attorneys or many other financial advisors for free.  (Again abgrogating necessity of this legislation)

This legislation has become a game of power and the willingness of Harry Reid committing "Hari Cari" to reach  this liberal idiological goal.  The legislation as it stands will help very few people.  The numbers that Chris mentions could be covered by the Veterans Administration or Indian Health Services.

I can't help you mental faculties.

Conservative......CNN news:Nopenhagen: US PRES 2 WKS LATE ATTEND 1 DAY, GORE JOURNEY BY TRAIN.

[ Parent ]
My point (0.00 / 0)
Your illustration uses an affordability argument about the necessary tests for health care.  Some how your problem immediately jumps to inadequate health care.  Not insurance.  

I was reinforcing your opinion of the necessity of this "health care" legislation.  I was pointing out various options, perhaps helping those that read these posts?  You can have a plan for getting the health care with the most marginal of costs because of several safety nets that are already present.  (Abrogating again the  necessity of health care legislation)

The financial portion of getting health care paid for can be assisted by the advice of credit counselors, attorneys or many other financial advisors for free.  (Again abgrogating necessity of this legislation)

This legislation has become a game of power and the willingness of Harry Reid committing "Hari Cari" to reach  this liberal idiological goal.  The legislation as it stands will help very few people.  The numbers that Chris mentions could be covered by the Veterans Administration or Indian Health Services.

I can't help your mental faculties.

Conservative......CNN news:Nopenhagen: US PRES 2 WKS LATE ATTEND 1 DAY, GORE JOURNEY BY TRAIN.

[ Parent ]
Your point has nothing to do with my point (4.00 / 1)

Full Court Press!

[ Parent ]
Yipes (4.00 / 1)
I recently sent an email to Gary Null, an uber activist who started the, mentioning your full court press idea (which I presented as the first rung of a bootstrap process). I've heard Null say many times that Americans shouldn't "re-elect anybody". (For a brilliant guy, his thoughts on political strategy seem awfully naive.) He interviewed Nader on his show about a week ago (one of many) on the subject of his latest book.

So, he is interested in large-scale change in Washington, D.C., but doesn't seem to have good ideas on how to achieve that. Being that he has such an interest, and a paucity of good ideas to achieve that interest, and since he is the principal in a radio network that serves up about a million podcast downloads per month, I suggest that, if you follow through and flesh out your plan sufficiently,

a) ask Null to ask his audience to support your plan by showing up to vote in the primaries, gather signatures, and (for a smaller number, of course) making themselves available to serve as the primary candidates

b) since you need a job, it wouldn't hurt to ask if there's any chance that you could be paid to manage the effort

c) even if a) and b) don't materialize, there's a large number of free articles on his website dealing with health issues; there's also his show, which is free to download and stream; also, for diabetes, Dr. Fuhrman ( says that he can cure adult onset diabetes by diet alone.  

435 Dem Primaries 2012
Coffee Party Usa

[ Parent ]
Thank you for all of the above (0.00 / 0)
I'll have something worked up by Sunday at the latest!

Full Court Press!

[ Parent ]
You're welcome (0.00 / 0)
You could also try calling into his show. In some of them, he takes calls from the audience. Maybe your best shot, though, is first trying to get a 5 minute listen from Doug Henderson, his Director of Operations. (Telephone # is on the contact page.) If I'm not mistaken, Henderson has a legal background, and may have a better appreciation of what it would take to take over mainstream political parties, from below, than Null does.

435 Dem Primaries 2012
Coffee Party Usa

[ Parent ]
Whose "victory"? (4.00 / 1)
While neither of those victories are assured, and while neither of those victories are anywhere as large as could have been, they are still two of the only long-term expansions of the social safety net in decades.  And, as such, they are still progressive victories--perhaps even large victories, given how rare any progressive victories have become.

The health bill may be a victory, but it is not a progressive one.  Yes, it marks a leftward shift in federal policy, of a size not seen for a few decades, but just because progressivism has been on the retreat for so long, does not mean that every step leftward is a progressive success.  The fact is, we wanted single payer, and compromised that away immediately; we then wanted a strong public option, and compromised that away nearly as quickly; and then we wanted a mild public option that could possibly be expanded in the future, and are presently compromising that away.  Even worse, rather than sticking to that weak PO as hard as possible to gain as much as possible in compromising it away, instead of proposing various bold trades we might demand for it, the left blogosphere is spending its time wondering whether no option at all -- with nothing in exchange -- is a victory for us.  It is not.  That doesn't mean it isn't better than the status quo -- god knows, whatever passes will be (much) better than that.  But that's not a victory for progressives, that's a victory for Obama and the Democrats.  What have we gained by keeping the public option alive for this long?  How much farther to the right would this bill have been without us?  The answer to that is the measure of how much this is a progressive victory.  My guess is, not much.

Progressive Block (4.00 / 4)
I know not everyone is going to agree, but not everyone agreed with the Progressive Block, either.

Agreed with what? There was no Progressive Block to agree with. When it actually mattered, progressives caved. As usual. They're going to all eventually vote for whatever crap Lieberman wants, so why even spend any additional energy on this healthcare bill?

I'm starting to think all of this energy on congressional votes is completely wasted. They don't listen to us, because they don't feel like they'll pay a price for ignoring us. That is the structural problem we need to remove, and all the whip counts in the world are only as useful as what you can do with them, which, right now, is sweet fuck all.

A good healthcare bill was a lost cause the minute 40 democrats, many of them pro-choice, voted for bloody coathangers. They made their bed, let's nail them to it in the 2010 elections. Never too early to educate people.

The full court press is a way to begin making them pay (0.00 / 0)
without getting official "credible" support.  Credible = compromised.

Full Court Press!

[ Parent ]
Lets kill this bill now! (4.00 / 5)
The problem here is that many of the folks that are supposed to be with us on this and other things are also concerned about staying in the good graces of the Democratic establishment.  For them to retain their insider access they need to do the odd favor for the "Man".  This post is a followup to the one Chris made yesterday titled "Even small victories against corporate America are enormous".  You may remember that it started with the phrase "Based on a conservation I had last night with a Senate Democratic leadership aide".  I think that tells us lots and fits into the pattern above.  Chris sat down with a representative of the power structure and got the Company line why Progressives should feel good about passing this fetid sack of shit that they called health care reform.  Problem is that we know its a lie and so do they but it is easier to throw us to the wolves than to stand up to the Corporate interests that own them so heart to heart talks are necessary.  After all we have always caved in the past so why shouldn't we do it again?  You can expect to see more of these little chats in the future.  What really scares the Democratic establishment is that we, meaning the Progressives, might stand up and say no.  You can expect their pleadings to get more desperate and their rhetoric to get more shrill in the coming days if the Progressives do so - ultimately we will be blamed for everything in the sun but if we don't cave we have the golden opportunity to make their lives a living hell.  If this bill goes down in flames so does the Democratic establishment and that's a fire I would pay to watch.  Frankly that's about the only thing we have left to gain in this mess.

Now my only hope is that including Sanders there are enough decent Dems left in the Senate to kill this bill one way or the other.  Its time we figured out who our friends are and who they are not.  In the "not" category lives Obama, the power players on this issue in the Senate and unfortunately a good chunk of the House.  

Same with firedoglake, MoveOn, etc. (4.00 / 1)
They were once demanding, demanding I tell you, that the bill had to have a ROBUST public option.  Now Jane Hamsher is peddling ANY public option as good enough.

The e-mails I get from MoveOn are hysterical (in every sense of the word).  If anything passes, the full progressive agenda will follow in its  wake.  If the bill fails, it's Palin 2012 for sure.

Mobilize!  Mobilize!  Call your congressman!  Send MoveOn money.  Get frenzied.  To the barricades!  Send more money.  And when the bill goes down in flames, look back with pride at our heroic efforts and send in another check.

And next year get ready to do it again for the next corporate giveaway, like the mangled wreck they'll call a jobs bill.

We're always calling on someone else to do something.  We need a tactic accessible to the nobody's that doesn't require the blessings of official leadership.  Full court press.

Full Court Press!

[ Parent ]
lessons here for future issues? (4.00 / 1)
this is somewhat off-topic - more like a suggestion for a different post -

but what can we learn from this? i am thinking of climate change, although it may already be too late for that as well. it would be worth fighting for a jobs program if there was anybody actually proposing legislation, maybe there is. i don't know what other major initiatives are going to come up either now or after the election. (the wars are a different kind of problem, i think. but maybe not.)

the left always loses these struggles largely for the motivations you outline here. we are handicapped by principle. the other side does not care. let the health insurance reform bill die, let the climate change bill die. they're OK with that.

it seems easy to conclude that until there are Senators who can credibly promise to walk away - and given history, it won't be credible until they actually do it at least once - then the only side with any leverage will be the conservatives. that we have to be willing to let it fail.

but the thing is, those principles are real, the arguments you are making don't go away because they're troublesome.

several people here have already talked about this conflict. i sure don't have answers in my pocket. but we have got to figure out a way to break out of this rut.

not everything worth doing is profitable. not everything profitable is worth doing.

Party of Life, 9/11 changed everything, etc. (0.00 / 0)
It amazes me that the pro-life, party of life, Schiavo-loving every life is precious to the very end, 9/11 changed everything when (just) 3,000 people died and we should spend literally trillions of dollars to make sure terrorists don't kill any more, Republicans are allowed to somehow not care about and actively oppose helping the tens of thousands dying every year for lack of health insurance.

It's entirely our fault for not making this case, loudly, publicly, repeatedly, endlessly until it takes hold...

...and perhaps the saddest example ever that everything is good news for Republicans.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

And this is why we lose. (4.00 / 3)
I don't think I could tell anyone who can't afford any health insurance that I would prefer they not have any insurance at all than have subsidized insurance from a for-profit company.  Further, I don't think I could tell anyone who can't afford health insurance that I would prefer they not have any insurance at all than for the Progressive Caucus to remain relatively less-influential than the Blue Dogs.  When faced with a choice between the status-quo, and providing subsidies to make it easier for low-income people to purchase private health insurance, I choose the subsidies.


Before I go any further, I want to take a moment to echo dr anonymous's thanks and add my own.  First I want to thank you for taking the time to thoughtfully address my comment, and as a front page post, no less.  Second, it is the fact that you are willing to be open and honest about your positions and views that the rest of us can have a useful dialogue on these issues.  Even if the end result is that we continue to disagree, I know that we do so in good faith.  It is one of the primary reasons I have so much respect for you, Chris.  Thank you.


Chris, I'm not mad at you for doing what you think is right.  Hell, I'm worried for myself just as much as anyone else.  I could get into an accident tomorrow, and it would screw me as bad as anyone.  According to my dentist, I really need oral surgery to correct my jaw (the correction of which would likely lead to fewer health issues, no less), but I can't afford that because my insurance will call it an elective surgery and not cover it.  Assuming they don't find some way to call it a pre-existing condition and rescind my coverage first.*

At some point, you have to realize that this behavior of being overly concerned is exactly why we're called "bleeding heart" liberals.  And because of that behavior, we're easy to roll.  Because like you, so many of us would rather take a few crumbs than not get anything at all so that at least some people will see a little bit better life.  What you miss is that the rest of us will continue to suffer, probably more than before, and the rich and powerful will get richer and more powerful.  You would choose to make society worse for the sake of a few people who's lives might be better.

And I say might, because you've made the cardinal mistake that I've pointed out before on this issue.  You're equating health insurance to health care.  This simply is not so.  Just because a person has health insurance does not mean they can suddenly afford health care.  Subsidies or not, health care remains expensive, and by mandating people get insurance, you're forcing them to spend what little money they do have on insurance, so they still won't be able to get health care.

You are not helping people by forcing them to get insurance.  And the public options being discussed in both bills are not strong enough nor robust enough to adequately contain costs.  Premiums will continue to rise faster than inflation, and people will continue to go without necessary health care.

I repeat, this is simply not a progressive position to take, Chris.  There is nothing progressive about allowing a bill to get worse just because your heart bleeds for people.

We need a progressive bill that actually brings about health care reform, not a faux reform bill that makes you feel better about yourself.  Neither the House nor Senate bills are reform.  They are not progressive.  They are not worth our support.**


* Yes, I know about the anti-rescission provision.  I've addressed this issue before.  It's no rescissions except in the case of fraud.  So, insurance companies just claim fraud, rescind, and you're left having to go to court to prove no fraud.  Which takes years.  All the while, you can't get the health care you need.

** And what really frustrates me is having to defend these bills against the lies and baseless accusations from the right and the insurance industry.  I don't want to support the bills, but I also don't want to allow lies to be perpetuated.  It's fucking maddening.

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.

disagree (0.00 / 0)
It makes no sense to give up on this bill, especially since we don't even have a final bill until we get the Senate to pass their version and we get a final version out of conference. Until we see that final version, we should be fighting to improve the bill, not apathetic or fighting to kill it.

But the bigger reason is that, quite simply, a bill will pass and become law regardless of how we feel. Obama and the Democrats in Congress have basically staked their legacies on it at this point, so they're going to damn well make sure something, anything, even the most craptastic triggered opt-in co-op piece of shit ever, passes, just so they can say they passed health care reform. Rahm Emanuel has basically said this verbatim - you think he's kidding? I don't, so that's why I have called my senators and representatives for months demanding a robust triggerless public option, real cost containment for private insurers, and other reforms I want to see. If I don't fight for those things, Congress has absolutely no incentive to not listen to the health care lobbyists greasing their palms in Washington.

At some point, you can water down the health care bill to the point that it's worthless and should be scrapped, but we're not at that point yet. Chris is absolutely right that this will save lives, even in the Senate's current form. Health insurance does not equal health care, but the fact remains that people will receive health care because of that health insurance. And that health care will save lives. Some on this thread have said the cost to us won't be worth saving that number of lives, but what number of lives are you using to make that argument? What estimated cost? And what is your cost calculation for how much a life is worth?

And as for those who are dissing the Krugman/CBO analysis of premiums, saying that he's just hiding the cost increases later on, are you aware that this will cause real wages to rise too? From what I've read, those increases in real wages will more than offset the increase in premiums.

Finally, Ezra Klein has made the point that passing this now will make it easier to improve the bill later on, even when we don't have a majority that's as strong as today. He cites the examples of Social Security, Medicare, and Medicaid. and he also argues that, if nothing were to mass, we wouldn't have a chance to pass health care reform for many years, and then it will suck even more than the bills we're debating today (citing HillaryCare from 1994 as his example). I find no reason to disagree with any of his points.

[ Parent ]
How much worse does it have to get? (0.00 / 0)
At some point, you can water down the health care bill to the point that it's worthless and should be scrapped, but we're not at that point yet.

We, as a group, as a community, of activists and progressives, said that the strong, robust, medicare-like public option with no triggers was the line we would not back down from.  That was the minimum point we chose.  And you backed down.  You and thousands of others.  You backed down.  You caved.  You broke.

Why the hell should anyone, least of all I, take you seriously when you say there is some nebulous point at which the legislation will no longer be acceptable to you.  Are we supposed to just take your word?  Your word is worthless.  You proved that when you backed down on the first threat.  When it counted the most, you turned your back.  No one has any reason to believe you'll behave any differently in the future.  We have every reason to believe you'll behave the same.  Guess who you're helping by acting that way.

That's right.  You're helping the conservatives.  You're helping the people you claim to be fighting against.  Because they know what I know about you.  That you don't mean what you say.  That you don't follow through on your threats.  So they'll just keep taking and taking, and you'll just keep giving up and giving up.

And guess what.  The Dem leadership know this, too.  They know they can't trust you to hold to your word.  So they can't afford to go to you when the stakes are high.  You'll cave, and they can't afford to be working with people who cave.

And the leadership knows that the conservatives won't cave.  They'll hold.  So any time the leadership has to get something done, guess which side they're going to side with.  That's right.  They'll side with the conservatives.  Every.  Time.  Because our side always breaks.

You claim to be fighting, but you're not.  You're just flailing your arms like a little child.  You have no strategy for winning.  Phone calls and emails and LTEs and all these other things mean jack shit if you don't have a strategy for winning.  We had a strategy until the thousands of people like you and Chris reneged on it.  Now, there's no strategy.  Chris doesn't have a strategy.  You don't have a strategy.  No one has a strategy for winning.  All you can think about is trying not to lose any more than we already have and deluding yourselves into thinking it's a win.

We lost.  Get that through your head.  We. Lost.  It happens.  Accept it.  We lost.  Now we should kill this bill so that it can't make things worse than they already are.

And it will make things worse.

Appeals to authority don't work with me.  You can quote Krugman and Ezra till the cows come home.  When they're wrong, they're wrong.

You use Krugman to claim that real wages will rise.  Under what rock have you been living the past three decades?  Businesses will never raise wages unless they're forced to.  With unemployment so high, businesses don't have to raise wages.  They just fire people who are too expensive.  Hell, even when unemployment was at pre-crash levels, that's what businesses did.

You hide behind Ezra to claim that it'll be easier to improve upon the legislation rather than try to start anew.  You assume that the people who will be affected by the legislation will be made better off by it.  But when people see how this legislation affects them--by forcing them to buy insurance they can't afford; by seeing their premiums continue to skyrocket; by seeing that even with insurance, they still can't afford to go to the doctor or get medication--they won't want to make it better.  They'll want to repeal it.

You and Chris say that this legislation will save lives.  Are you both arguing that I don't want to save lives?  That's the implicit point of your argument, you know.  For me to argue against you, you think I'll have to say that we shouldn't save lives.  That would make me a cold and heartless bastard, and you know no one would want to be like that.

I'm arguing about saving more than just lives.  I'm arguing about making sure that people can actually live their lives with dignity and respect.  I'm arguing that the legislation as it is now forces people into lives only one step up from slavery.  Indebted to the insurance companies.  Forced to bow and scrape their heads at work for fear the boss will fire them just so they can make enough to pay the extra costs this legislation forces on them.  How much indignity and disrespect and humiliation can a person take before they break?

You're intentions are good, but you're paving the road to hell with them.  Hell on earth.

There is more to life than just being alive.  Just living isn't enough.  You have to have something to live for.  This legislation tries to take that away.

Polish a turd all you want.  It is still a turd.  Time to flush it down the toilet.

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 ]
LOL! (0.00 / 0)
How the hell do you know that I "backed down", "caved", "broke"? How do you know anything about what lines in the sand I drew? What gives you the right to lump me in with your group of activists and progressives and claiming I'm some sort of sell-out? So you can have this moral authority to inform me we've lost and I should just give up? What a load of defeatist shit. And you're saying I'm the one who doesn't follow through, which is especially rich.

Go ahead and ignore the facts I present with your fact-free analysis and reactionary nihilism. Yeah, I'm "hiding" behind the analysis of people who've read the legislation and made cogent arguments about it. You're bringing nothing to the table but drama. (This legislation takes away what people have to live for? Do you even know how overwrought and ridiculous that sounds?) If you'd put more of that passion into something constructive, maybe you could help health care reform. Or, you can continue to misplace your anger on a bunch of anonymous people on blogs. Your choice.

[ Parent ]
Sigh. (0.00 / 0)
So much bullshit in so little space.  Like listening to a republican.  And debunking it always takes far more time than should really be necessary.  Honestly, I should hold you to the same standard as them, but I happen to think you're arguing in good faith.  So, the long reply (though due to time constraints, I have to skip over a bunch of stuff).

You asked how I know you backed down?  You admitted it.  Your words:

At some point, you can water down the health care bill to the point that it's worthless and should be scrapped, but we're not at that point yet.

Yes, we are.   That was the whole point of "strong, robust, medicare-like public option with no triggers or kill the bill."  We're long past that point, and you're still saying we shouldn't kill it.  That's why I can say you caved.  Because you did.  You admit it right there in those words you typed.

You're trying to play the insider game, despite the fact that you're an outsider, just like--with very few exceptions--all the rest of us.  We don't get to make backroom deals.  We aren't the negotiators.  We don't get to decide what gets compromised and what doesn't.  All we've got is our uncompromising position and our willingness to hold people accountable.  That's it.

Go ahead and ignore the facts I present with your fact-free analysis and reactionary nihilism.

What part of what I said isn't based on facts?  Are you saying businesses will raise wages without being forced to?  What evidence do you have to prove me wrong.  Paul has thrown up the tables and charts often enough just on this site to prove me right.  Here's just one example.  If Krugman is correct, then you should be able to point to where in either of the bills this provision is explicitly stated.  (I won't hold my breath.)

Are you saying that high unemployment leads to higher wages?  Simple economic theory that's been proven time and time again says otherwise.  The larger the labor pool, the lower the wages because people take low paying jobs rather than not have a job at all.  This keeps wages low.

Are you saying that businesses don't fire people when they get too expensive to keep?  This is what businesses are doing right now.  Hell, gjohnsit put up a diary just today digging into the latest unemployment numbers which shows that businesses are still firing people far faster than they're hiring.  How is that not a fact?

Are you saying that if and when people are made worse off by this legislation, they'll still prefer to make it better rather than do what people normally do when faced with something detrimental to their well-being (real or perceived): try to get rid of it?  This is basic human behavior.  When something bad is going on, you want to stop it, not continue it.  The only way that doesn't happen is when you can convince people that e.g. up is down, left is right, war is peace.

And then you have the gall to call me a "reactionary nihilist" after getting all righteous about what I said about you.  Talk about hypocrisy.

I talk about you based on what you've done.  Same as I would any politician.  Are you saying you're lying about what you've done?  I hope not, and I respond as if you're not.  But if you are lying about what you've done, you may as well actually be a Republican for all I care.

And yet, you're claiming you know about my philosophy, as if the few words I've typed here have shown you my soul.  You don't know jack about my philosophy.

Nihilism says that life does not have any intrinsic value, only that which we give it.  I never said life has no intrinsic value or meaning.  I said that there is more to life than just living.  If life is all that matters, then you would be perfectly fine being the most pathetic slave in all of existence with no hope of ever being anything other than trash for others to kick around.  Thousands of people have committed suicide for lesser reasons than that.  Millions have chosen to fight and die rather than live a life downtrodden.  For fuck's sake, our country was founded on the principle of freedom.  People died for it.  And the whole concept of being pro-choice requires one to recognize that it's not enough to just be alive.  For you to be correct, you'd have to conclude that the founding fathers and the entire progressive movement are made up of a bunch of reactionary nihilists.  That's just plain stupid.  Clearly, there's more to life than just living.  Which is exactly what I said.  And I based it on reality and verifiable facts.  I never thought I'd have to point out something so frickin' obvious on this site, though.

Yeah, I'm "hiding" behind the analysis of people who've read the legislation and made cogent arguments about it.

I bring facts that show both Krugman and Ezra are wrong, and all you can do is whine like a Republican.  When I mention Paul and gjohnsit above, I use them because they have already compiled the data I want to use for supporting evidence in my argument.  The argument easily stands without Paul and gjohnsit.  When you bring up Krugman and Ezra, they are all you have for your argument.  That's why it's called "appeal to authority" and why it's a logical fallacy.  You're blindly following authority figures, hiding in their shadows, rather than thinking for yourself and countering with your own arguments.

I've read the House bill, as much as anyone with limited time can.  We already know from the original fight that the Senate bill is worse, so I haven't bothered with that one.  Have you read either of them?  I still have the House bill saved, so I can reference it when things like what you claimed come up (though it wasn't necessary in either case).  If the House bill doesn't do something already, the Senate bill isn't going to fix it.  And while I agree with Krugman and Ezra on some things, that doesn't mean I'm a ditto-head.  I have a brain.  I use it to think for myself, not defend some ideal of a technocratic establishment that replaces the current leaders with your own.  Because the latter is what appeals to authority inevitably lead to.

If you'd put more of that passion into something constructive, maybe you could help health care reform. Or, you can continue to misplace your anger on a bunch of anonymous people on blogs. Your choice.

I don't fight unless there's no other choice or when there's no strategy to win.  I put my passion into smart fights.  I'm not demanding assured victory.  I just demand a path towards it.  There is no such path in your retreat on health care.  You are admitting, openly, that you are willing to continue ceding ground.  Giving up more.  Why should I fight to lose more?  This isn't a battle we even have to fight.  We should be fighting to kill the entire bill rather than make it a law that we have to turn our lives over to the insurance industry.  That would be something worth fighting for.

I'm not going to waste my time and efforts on the foregone conclusion of failure.  I've got better things to do with my time, like pick the lint from my navel.

I argue with people like you and Chris here because all you have is the same failed strategy, and I want to change that.  See, I actually want to win.  And if I can get people to recognize that the current strategy doesn't work, and get them to try a different strategy, then I can put more time into fighting for the things that rely on a winning strategy.  But we actually have to have that new strategy, first.  It's a prerequisite to all the other fights.

I've tried to argue what strategy we should be following, but only a few seem to agree and want to try it--not enough to make a difference--and I can't force it on any of you.  Rather, you seem stuck with continuing to do the same thing that always fails.  It's insane.  I don't know what else to call it.

For example, you said originally:

If I don't fight for those things, Congress has absolutely no incentive to not listen to the health care lobbyists greasing their palms in Washington.

Fight how?  By calling and writing letters and holding rallies and on and on?  Those are just tactics.  Tactics are utterly meaningless without a strategy.  And what is your strategy?  To hold more rallies and write more letters and call your congresspeople more often, yadda yadda.  In other words, you don't have a strategy.

A strategy would be like us saying, "we want this or else we vote you out."  And then you have to hold to that.  If there's no "...or else," and if you aren't willing to hold to it, then our congresspeople have no reason to heed us, let alone listen.  Without backing up our threats with action, it's just a bluff, and we have a long, long history of only bluffing.  We've given our congresspeople no reason to believe we'll do anything different.

And it's precisely because we don't back up our threats with action that "our" congresspeople listen to the corporate interests.  The corporate interests back up their words with actions.  We don't.  It's as simple as that.

So, you can continue to call and write and do all the other activist things without a strategy and continue losing just as always, or you can recognize a failed strategy when it's stuck to your face and demand--along with me and a few others--that it's time we change that.  With enough of us demanding a new strategy, we'll eventually reach critical mass.  Sadly, I don't expect it to happen any time soon.

So, I throw your final words back at you.  Your choice.

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 ]
I see you've made your choice (0.00 / 0)
Good luck with that.

[ Parent ]
Have to agree with Chris (4.00 / 2)
And I find it odd that his opponents keep pointing to a "lack of negotiating skills" supposedly evidenced by his position.

I doubt those expressing this sentiment have ever negotiated anything.

Progressives entered this debate with a weak hand.  You don't think so?  Why do you think they gave up single payer from the git go?  Is it because they're stupid?  Or is it because single-payer was a non-starter politically - because it didn't even get you to first base - regardless of its merits.

Yes, I'm as disgusted as any of you with how easily the right-wing and the insurance industry came to dominate the debate with bullshit.  And yes, I can only wonder what this might have looked like had Obama put his ass on the line for it.  But only wonder.  It might have gotten us to a different and better place - or not.

If progressives were in a stronger position, then there would be some Red State Republicans in severe jeopardy over their idiotic stands on Health Care Reform.  But there are none - not one is in this condition.  Think about that.

We can holler, threaten and cajole, to some extent, but the Overton window is stuck and our best efforts were only enough to budge it slightly.

If you all had any experience in negotiation you'd know that it's sometimes about getting the most you can out of a weak hand - shaking the apples out of the tree.

Our side has done a creditable job of that.  Sure, it's disappointing that we haven't been able to do more - but let's not lose sight of what we have been able to do.

And you may say, what difference Obama or McCain?  I'd answer that with if we had McCain we'd still be discussing "electing more Democrats" as the solution.  We're well beyond that now.  Instead we've spent the whole year discussing Health Care Reform.  That MAY pay some dividends down the road.

sTiVo's rule: Just because YOU "wouldn't put it past 'em" doesn't prove that THEY did it.

I am reminded of (0.00 / 1)
this Youtube video featuring David Obey (I can't remember if he's a hero or villain this week; he proposed the war tax, but he also, quite predictably, voted for the Stupak amendment), which was also written about by David Sirota.  

I fully expected the "idiot liberal" brigade to be out in force in the comments for this post.

Things You Don't Talk About in Polite Company: Religion, Politics, the Occasional Intersection of Both

Lets not forget the political side of this (4.00 / 3)
While I'm outraged by the wanton cowardice of Obama & Company and how they sold us out from the very start not to mention the corruption of the House and Senate we shouldn't forget the long term political dimensions of this mess.  I do not accept the common belief in the liberal chattering class that any bill is a win for the Democrats.

What we are facing is passage of a weak and by and large useless bill that will be called Health Care Reform that won't even come into effect until 2014 or later.  What will be the blowback for this?  How will the voters reward us when the insurance companies justify another 30% increase in rates because of the new Health Care Reform law?  The drug companies are doing that right now - why shouldn't the gods of the insurance companies?  What will young voters say when they are fined for not having unaffordable sham insurance or have to spend hours proving to the power structure that they really can't afford insurance even with a subsidy?  The Dems will be rightly punished and it will be a political disaster of incredible proportions.

Sadly, I agree 100% (4.00 / 1)
Yes, this bill will get lots of people on the rolls, but at what cost to them?  At what cost to the taxpayers?  

The bad in this bill is not outweighed by the slight good.  The worst part is that if it passes, people will think that the issue is handled and there will be no incentive to get anything else passed.

[ Parent ]
Chris, like others, I can appreciate your position (4.00 / 3)
but like others, I have to take exception to the idea that having health insurance means that you get health care. I am currently unemployed and broke. My family has picked up the cost of what insurance I can get. I could only get very basic insurance through AARP because I've been denied due to pre-existing conditions. Mandating that insurance companies have to insure me regardless of pre-existing conditions isn't going to help me, or help others in financial difficulty.

The very poor cannot afford co-pays for office visits. My co-pay for my family doctor is $40. That right there will prevent a huge number of currently uninsured from getting care even if they are given the same insurance that I have now. Right now, my family is picking up the $40 if/when I go to the doctor, but if I were on my own, I'd never go due to the co-pay.

In addition, you seem to assume that regulations regarding things like rescission will be enforced. However, according to recent reports, rescission is already against the law. Insurance companies do it freely however, because they know that the regulators won't do anything to prevent them from doing it. And the legislation being proposed apparently relies on those same regulators to enforce any further regulations. I have no confidence that any of the regulations will be enforced at all.

Let me also mention something that I've run into with my own insurance. My insurance is supposed to cover "routine" screenings. Among other tests that I need, I really need a colonoscopy since my grandmother died of colon cancer. My insurance is supposed to cover 80% of the cost. My family could pick up the 20%. However, if the doctors find anything at all (including the common finding of polyps), the screening is no longer considered routine, but "diagnostic", and is no longer paid for. So basically, if they find anything at all, I'm on the hook for 100% of the cost of the screening, as well as 100% of the cost of any treatment until my $5000 deductible is met, after which I'm on the hook for 20% of it. I can't afford it, so I'm avoiding the crap shoot entirely of whether they will pay for the screening or not.

I guarantee you that this will be the norm for the "routine screenings" that insurance is supposed to pay in full.

Again Chris, I applaud your compassion. However, health insurance will not mean that people get health care. It will only mean that they have an insurance policy that ensures it will still be too expensive for them to get health care.

The question is, does this set us back or move us forward? (4.00 / 1)
It's very possible for a piece of legislation to appear like it's getting something done but is really moving us backwards.  That was supposedly the reason why most Democrats opposed the 2003 Medicare bill even though it would've provided prescription drug coverage to seniors - not only was it a huge giveaway to drug and insurance companies, it was a way of undermining Medicare's finances. (I wonder how much of the opposition was due to the mere fact that it was being pushed through by a Republican trifecta.)

So just as we opposed a bill that ostensibly provided drug coverage because it actually moved us backwards, we have to see if this bill, that ostensibly provides health insurance, will move us backward or forward.  Which is it, and why?

if you support this bill, you implicitly oppose single payer health insurance from ever taking shape, i think - at least short of nationalisation, which is verboten in the u.s. (0.00 / 0)
the creation of a single, massive pool of insurance recipients who are all obligated to pay insurance companies, with the public sector taking up the slack by taking on the care that's unprofitable is what this seems to be abuot, structurally.  it will create unassailable insurance companies.

if that's okay with you - which is reasonable - some people think a monopoly or oligopolistic market solution is just as good - then that's fine.  if that's not okay with you, then you're going to object.

but we should be clear (i think?) that the main strength of the public option - that it could grow into something more - is probably dead in the water with this kind of solution.

This kinda feels like a stab in the back from a friend (0.00 / 0)


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