There are still ongoing, undecided and winnable public option fights in this bill

by: Chris Bowers

Tue Dec 29, 2009 at 18:00


While the Medicare buy-in and new public health insurance option both likely dead for this bill, there are still provisions for public health insurance and public health care in the bill.  These provisions include:

  • Medicaid expansion.  Both the House and the Senate bills are projected by the CBO to cover 15 million more Americans with Medicaid or CHIP than current law (although Paul Waldamn projects the difference to be 15 million in the House bill, and 12 million in the Senate bill).  Both Medicaid and CHIP are public health insurance options, and the fight to expand them is ongoing.  This fight is ongoing.  The House bill expands Medicaid to Americans at or below 150% of the poverty level, while the Senate sets the figure at 133%.  

  • Community health center expansion. In exchange for his vote on cloture, Senator Bernie Sanders secured funding in the Senate bill that will double the number of community health centers in America:

    The House bill provides $14 billion in funding for the federal health centers and service corps. Sanders says that indications from the White House and Democratic leadership are that there is a "good chance" the final bill will do the same. That would translate to health centers in 10,000 more communities throughout America within 5 years, and increase the number of people served by over 100 percent, to 45 million. It would also create 20,000 new primary care practitioners, dentists, nurses and other healthcare professionals. Sanders emphasizes a George Washington University study that shows the $14 billion expenditure would save money--$23 billion in Medicaid alone--"because you're keeping people out of the hospital and out of the emergency room. Now if this is not a win-win-win situation, I don't know what is," he says.

    Going beyond public health insurance, this is public health care.  Also, as passage makes clear, this fight is also ongoing, since we are talking about "good chances" instead of "done deals."

  • Community Living Assistance Services and Supports Program The CLASS provisions in the health care bill are a government-run program that will provide individuals long-term disability care.  The program was championed by the late Ted Kennedy.  The CBO estimates the program will have 10 million enrollees by 2019 (page 3).

    Always a champion of the people, Lieberman previously claimed that he would filibuster the bill if the CLASS program was not removed. While Lieberman, who is always true to his word, failed to follow through on his threat, the fight for this public program is not over.

As Ed Kilgore astutely noted, the divide among the center-left over the health care bill is, and has always been, between:
  • Centrists / Third Way / neoliberals who favor expanding health insurance through regulated and subsidized private providers,

    and

  • Left / liberals / progressives who favor expanding health insurance through public providers
If this is the central ideological battle among Democrats--and I have never seen a better analysis arguing otherwise--then the public option fight always encompassed more than just the creation of a new public health insurance program.  It included Medicare, Medicaid, CHIP, community health centers, the CLASS act, and more.  While some of those fights are over, not all of them are.  This article lists three public options fight that are ongoing.

Even though the Medicare buy-in and a new public option program appear to be distant possibilities for this bill, champions of public health insurance and public health care in Congress should be demanding expansions of other public health programs in return for their votes.  This is what Bernie Sanders did in the Senate, and he got some real results.  With many Blue Dogs and Conservadems primarily looking for symbolic victories that allow them to differentiate themselves from the left, the Sanders model can be replicated and other victories can be achieved.

Chris Bowers :: There are still ongoing, undecided and winnable public option fights in this bill

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Good stuff (4.00 / 8)
But please don't let Joe Lieberman hear you call Medicaid and CHIP public options.

Maybe we should use a code name like "Private Freedom Health Insurance" until the bill passes.


better yet... (4.00 / 1)
Rename them Abstinence-Only Purity Terms (A-OPT)

They call me Clem, Clem Guttata. Come visit wild, wonderful West Virginia Blue

[ Parent ]
How about... (4.00 / 2)
we call them Financial Unity - Joint Operational Entities or FU-JOE, for short.

[ Parent ]
It's not enough. (4.00 / 6)
Even if we "win" the battles on those items listed above, the bill still won't be worth passing.

So the government forces 30 million people to buy faulty insurance from greedy corporations that should have been regulated like trusts, and in exchange 12-15 million get the privilege of being treated like lepers in their homes states. (Not to mention that doctors and hospitals can bump medicaid patients off of treatment rolls for something as innocuous as missing an appointment.)

It's not enough.


You are right it isn't enough... (4.00 / 1)
But what do you suggest in its place that realistically has a shot at passing, instead of passing this, using its benefits and work to fix its faults such that was done with Social Security?   The filibuster doesn't have the support to be changed, the nuclear option doesn't seem to have the support and reconciliation doesn't have the support.     I say pass it and fight again to fix it.   Sometime's it takes several incremental changes... big super bills are a near impossibility in the congress of the last Decade.

[ Parent ]
Addendum (4.00 / 1)
Just because I feel this way, doesn't mean I don't also support fighting for as much as we can in Conf.

[ Parent ]
Given that the industry is already getting what it wants (4.00 / 6)
from the deal with the mandate and subsidies, which means any improvements would have to come without offering them anything, and that all the existing barriers will still exist when we try to fix it, I don't understand why you think it will be easier to get progressive fixes as a stand alone than it has been to do it as part of a larger bill.

As for the Social Security analogy, it always depended on the creation of a public program, which has been stripped from the bill.  With SS, the original program created a constituency to support it, and this helped lead to its expansion.  Without the public option, I don't see how the analogy has any relevance to this debate.

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 ]
Its MUCH better than the status quo is... (4.00 / 2)
And Sorry but the public option is NOT the only way to reign in costs.  Personally, I'd be just as happy with price regulation.  Of course, that would be difficult as well.     Either way, killing this bill and trying to simply start over with no strategy or no obvious path to victory is a big tactical error, IMHO.

[ Parent ]
What's the strategy and timeline for "fixing" the bill? (4.00 / 1)
Either way, killing this bill and trying to simply start over with no strategy or no obvious path to victory is a big tactical error, IMHO

True, if the past is our guide, the left would start over without a plan or a strategy. But, perhaps, some might take the recent struggle to put together a bill as a learning experience and develop a left-leaning approach rather than the "bipartisan" approach that produced this initial attempt at HCR. Maybe?

Your analyses also pertain to the putative "fixes" in the future - what's the strategy for enacting even more reform when, for many, the battle will be over when Obama signs the bill and declares "mission accomplished"?


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


[ Parent ]
I didn't say anything about whether to kill the bill or (4.00 / 1)
whether the PO was the only way to reign in costs. Are you conceding that all the barriers to fixing the bill now will still be there later, that next time the industry will have zero reason to play ball and that the SS analogy is inapt?  

If you want to make the argument against killing the bill, that is one thing - but your arguments above seem to miss the mark, and you didn't attempt to defend them.

For the record, I support the effort to kill the Senate bill (which is what many people are referring to) because I believe it will improve the bill - no doubt not enough to satisfy me, but if it's going to pass (I believe it will) it might as well be better.  

Since there is no effective price regulation, its unclear why the fact that there might be other ways to achieve what the PO promised matters.

Also, the PO was about something more then price regulation, as John Walker explains well.

The weaknesses of this bill are (partly) a result of a lack of mobilization on the left - this will be necessary to overcome all the structural barriers that exist today and will in the future - i.e. in order to "fix the bill."  That is the strategy - popular mobilization.  (The kill the bill push may well be the start of that, making it valuable regardless of any other impact it might have.)

Because the things you cite as problems now will still be there later, and because the SS analogy is mistaken, the "the fix it later" talk seems more like a slogan than a strategy.  

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 ]
thanks for the fdl link (0.00 / 0)
walker nails it...

[ Parent ]
"Fix it later"? Please... (4.00 / 5)
Yeah, that'll work, just like it did with Medicaid Part D, and the original AHIPP. Oh and NAFTA, they're gonna get around to fixing that any day, now. Just like they said they would, about 15 years ago.

And please stop comparing this mandatory bailout of corporations to Social Security. It's not the same. If Social Security had been designed by the hacks and thieves in government today, it would look nothing like it does.
 It'd be a lot more likely to be a mandate to force people to participate in the same sorts of derivatives gambling that brought our economy crashing down, about a year ago. There's just  too many counterfactuals in the way to make the Soc Sec. comparison meaningful.

In short, the impetus is not on me to show how "we can get there". According to the situation you describe, that's not even possible.

If you really want it to be "fixed later", then you should work to pull the mandate from the final bill. It's the only thing likely to make them come back to the table.

I just want this POS bill killed. That's it.  


[ Parent ]
And then what? (4.00 / 1)
I have no problem with the mandate because the mandate is what allows the death of pre-existing conditions, annual and lifetime caps.

If you kill it, then what?   We live under the far far worse current system...

What's the strategy for passing a new bill...  

I didn't say improving would be easy, but its a hell of a lot easier than trying to craft a new Mega bill with a Senate that won't nuke the filibuster or use reconciliation.  In the meantime, the current system which is far far worse will help to keep many many more uninsured.


[ Parent ]
Got a call from DFA this afternoon (0.00 / 0)
soliciting funds, but it sounds like they are wheeling into action for the reconciliation fight.

I asked if Dean was going to run again, LOL.


Didn't Dean come out in favor of the bill (0.00 / 0)
flipping from earlier opposition due to some items that were put back into the Senate bill?    Just wanted to clarify that he switched his position but also supported fighting to improve the bill in reconciliation which I agree with.

[ Parent ]
Sorry... (0.00 / 0)
I meant Bill Reconciliation as in Conf Committee.

[ Parent ]
Now there's the Bob Herbert piece (4.00 / 1)
http://www.nytimes.com/2009/12... on this vicious attack on the Cadillac plans.

And the Mandate will still force people to buy policies they can't afford (no the subsidies are not adequate).

Oh, by the way, would you support passing the bill if the Stupak amendment is in the final bill?

Full Court Press!  http://www.openleft.com/showDi...


Actually that is pretty great (0.00 / 0)
Employer plans should be taxed.  It would be ideal if people were taxed on buying health insurance like regular income.  That would remove the special advantage health insurers have been given.

http://transgendermom.blogspot....

[ Parent ]
At 40%? (4.00 / 5)
This is viciously anti-worker.  Viciously.

Full Court Press!  http://www.openleft.com/showDi...

[ Parent ]
Some might disagree with the idea of taxation (0.00 / 1)
But I personally think that our taxes provide valuable services for the most part.

http://transgendermom.blogspot....

[ Parent ]
Well... (0.00 / 0)
If it works the way its supposed to it will be good.   However, if it doesn't this is one of the biggest politically liabilities in this, way more than the Mandate.

[ Parent ]
Then you should be glad to pay more of them (0.00 / 0)


Full Court Press!  http://www.openleft.com/showDi...

[ Parent ]
I wouldn't actually be paying more of them (0.00 / 0)
But possibly the executives at my company might.

http://transgendermom.blogspot....

[ Parent ]
No wonder you think it is a good idea (0.00 / 0)
I wouldn't actually be paying more of them

Always easy to support other people writing checks, eh?


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


[ Parent ]
But The whole plan isn't taxed at 40%. (0.00 / 0)
The whole plan isn't taxed at 40%, just the part over $23,000 or $8500 for individuals.   This could work well, then it may not.   If employers take the time to negotiate rates based on their buying power, then the tax would not be used.   That's the purpose of the tax in the first place.   Million dollar question is WILL they do this.  

Which leads us to the biggest problem of the kill it/don't kill it debate.  Most of the argument is based on speculation and little on hard fact.


[ Parent ]
Cpmparison (4.00 / 5)
The cadillac tax is much higher than for regular income.

The top federal income tax bracket is 35%.  The top rate for most people would be 25%.  Jeff's right.  

Many, if not most, of these plans will be dropped and replaced by bottom-rung managed care plans.  Workers will get less and if you think they will get a raise to compensate, I have a bridge to sell you ....

The alternative in the House bill is a surcharge on millionaires (it kicks in on couples at $1 million and singles at $500,000).  The House bill covers more people, has no cadillac tax.  The Senate bill is just really bad.  


[ Parent ]
40% after the first 20,000 (0.00 / 0)
Either way the current lack of taxes on health insurance money is part of the problem.  That is a huge subsidy to the health insurance industry.

http://transgendermom.blogspot....

[ Parent ]
Actually (4.00 / 1)
For singles it is 40% after the first $8,500.  That does not cover a PPO in metro NYC.  Since the dollar amounts are not adjusted for inflation, more of the country will be effected as the years go by.

[ Parent ]
I'm not sure this is the way these two camps divide (4.00 / 2)
Neoliberals seem to be fine with some amount of expanded spending on programs traditionally viewed as "welfare" like Medicaid.  Their opposition is more about universal programs like Social Security or Medicare (or the public option).  The battle over welfare reform under Clinton was about increasing means testing (making sure that it only went to the truly deserving poor) - at that time, they argued that doing so would allow for more funding to help the poor (which didn't materialize.)

On the other hand, progressives are more concerned with increasing universal programs (or making non-universal programs more universal.)

My point is, I think the expansion of Medicaid is something people in both camps can support, but it's actually more in line with the neoliberal camp than the progressive camp at least in terms of means. It's not so much that its a government program, but the type of government program that matters.

(While I'm not certain, my impression is that the community health centers, because they will be providing direct care, are more consistent with the progressive world view.)


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.


Expansion of Medicaid is neoliberal (0.00 / 0)
I don't agree. I'm  more in the Ed Kilgore camp that the neoliberal ideal is to use the for profit community to intervene in social problems rather than employing the welfare state.  

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

[ Parent ]
Here is the question (0.00 / 0)
Is TANF a progressive policy, or a neoliberal one?  It doesn't involve using for profit institutions - it is a government program. Yet I would say it is neoliberal. Public programs can promote economic opportunity and security, but they don't always do so. To me, that is the important question. Social insurance is progressive - but not all public programs are.  Private prisons are certainly neoliberal, but are public prisons progressive?  I think Kilgore has identified one important dimension of the ideological divide, but not the only one.

I'm not suggesting that progressives shouldn't support a Medicaid expansion, and extending health insurance to the poor is a progressive goal.  But in terms of the means to get to that goal, I don't see how the expansion of a means tested program which is only for the poor can be seen as progressive.

I also don't see it as contributing to progressive feedback loops.  The Republicans would love to paint all health care reform as "welfare," and the Medicaid expansion encourages that meme.  There is a world of difference between adding to Medicare (a social insurance program) or Medicaid (a "welfare" program).  

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 ]
crux of the matter (0.00 / 0)
So any kind of government outlay that relies on means testing as a requirement for the allocation is non-progressive? Only truly universal programs are progressive? Not sure I agree with that. For instance, a graduated income tax, where wealthy people pay at higher rates, is a sort-of means tested approach to funding the government, and that is far more progressive than an approach where everyone would pay the same % of income. I see that in the context of healthcare, Medicare is more progressive than Medicaid.  But certainly Medicaid is more progressive than providing poor people with government subsidies to buy private health insurance, which is the more neoliberal approach.

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

[ Parent ]
I'm not sure that progressive taxation is means tested (0.00 / 0)
But I see your point. (Actually, since everyone pays the same rate at each level, I do think progressive taxation is univseral - no one pays on the first so many dollars, then we all pay the same rate on the next bracket's worth, and so on.)

I'd say that policies that are punitive towards the poor are often neoliberal. Indeed - I think that is a rather important feature of neoliberalism (think welfare reform, immigration reform, "humanitarian" bombings and sanctions, etc.)

I agree with this:

But certainly Medicaid is more progressive than providing poor people with government subsidies to buy private health insurance, which is the more neoliberal approach.

But as you say:

Medicare is more progressive than Medicaid

This is all relative.  And neoliberalism versus progressivism cannot be boiled down to a single dimension. In fact, that was what I was attempting to say in the first place.  

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 ]
Totally agree n/t (0.00 / 0)


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

[ Parent ]
re: sanders (4.00 / 2)
In exchange for his vote on cloture, Senator Bernie Sanders secured funding in the Senate bill that will double the number of community health centers in America:

couldn't more dems have followed bernie's tactic? even at the state level

like franken for MN, brown for OH, feingold for WI

and than they could tout that in their re-election


They should have... (0.00 / 0)
Apparently they didn't though.   Of course since Bernie isn't a Dem, he isn't being threatened with withholding campaign funding or the like.

[ Parent ]
What are the chances... (4.00 / 1)
...that the House progressive caucus leadership understands the agenda items and strategic vision in this post?

Clearly, we can't count on Leaders Hoyer or Clyburn as progressive advocates. Pelosi, though perhaps more disposed to support these items, as Speaker must bridge the caucus with the sole focus on finding 218, so she can't be an advocate for one side. The incoherent babblings of progressive caucus co-Chair Lynn Woolsey don't inspire a lot confidence. So who, exactly, do we have fighting this fight? What are the chances that actually have a plan?

/cynically depressed lament

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


strike the mandates (4.00 / 3)
If they remain, the insurers will have an enormous financial advantage to smother any future attempts at reform. Nothing like a captive market to boost profits.

If you think it's bad when they're throwing a million dollars a day at Congress to get their way, wait till they can afford to throw ten or twenty million a day. At that point, we'd be lucky to get even the drawn-out kabuki and miniscule crumbs we're getting now.


Question? (0.00 / 0)
If you strike the mandates, then how do you get rid of Pre-existing conditions and annual and lifetime cap?  How do you keep the system from being abused?   I don't like the mandate, but I accept the necessary evil of it to get the above mentioned items.    How can those be achieved without it?

[ Parent ]
You're not thinking like Presidents Nelson and Lieberman. (4.00 / 1)
It shouldn't be your job to worry about the system being abused. That's what weenie-ass wonks who don't get their way do.

What you need to do is help pull the mandate out and then screech like hell if they try to put it back in. Don't mention abuse of the system, don't mention anything that won't help your argument. That's not what a Nelson or a Lieberman does.

Not to mention that insurance policies already carry tools for dealing with preexisting conditions that do not involve recision. Recision and banning due to preexisting conditions should not be negotiating points. They should be presented as symptoms of the insurance companies' malfeasance.

The annual and lifetime caps have nothing to do with preexisting conditions, they are just two more ways that insurance companies "keep costs down" by denying care. Otherwise, they are irrelevant to the discussion of mandates.


[ Parent ]
NO Will... (0.00 / 0)
Ignoring the mandate with Pre-existing conditions WILL DRIVE PRICES SKY HIGH.  The people joining will be people already sick who have never paid in, greatly increasing the overall pool.  I'm sorry, based on everything I have studied, people I have talked too, etc. I feel you are completely wrong on this and don't have a full understanding of the Mandate and its relation to aspects of the bill.

Instead of trying to remove the mandate, the better course of action is to figure out other cost control measures and regulation that can be brought into the bill to achieve the same results of a PO element, without the PO.


[ Parent ]
They've all been taken out (4.00 / 1)
except for the excise tax, which only controls costs temporarily, and then only by increasing the burden on the middle class and union members.

If you can think of other cost-control measures that won't be stripped away by industry-owned Senators, I'd love to hear them.

In one respect we're talking past each other, you're saying my suggestion will make the bill worse, and I'm agreeing and suggesting that we do so on purpose.

I understand that the bill without a mandate causes an untenable situation, we want that untenable situation to force the other side to come back to the bargaining table. Otherwise there's no reason to think that it will be improved later.

You do get that forcing people to buy defective products or be fined by the IRS is a huge loser come election time, right?

If no one else has any compelling reason to revisit the bill, that's what we'll be stuck with.


[ Parent ]
see MA prior to 2006 reform (0.00 / 0)
we had regulations re pre-existing conditions, modified community rating, etc prior to the 2006 reform which introduced mandates.

it's called regulation -- i understand that many state govs and certainly the national gov think regulation is bad for industry. but that's not because of the lack of mandates. in fact, if it were up to me i'd insist on a demonstration period of good regulation FIRST, prior to implementation of the mandates (maybe with a trigger? ).

(note: actually if it was up to me, we'd have something like hr 676 for single payer comprehensive universal healthcare: expanded and improved medicare for all.)


[ Parent ]
Correct me if I am wrong, (0.00 / 0)
But the pre-2006 regulations LIMITED pre-existing conditions, but did not eliminate them.  They allowed for a small gap.  

I'm 100% for regulation, in fact I prefer it to the PO personally and only second to Single Payer or a modified hybrid system like France.


[ Parent ]
we should fight the excise tax like hell (4.00 / 7)
That should be a deal-breaker. The Democrats have been promising people that if they like the insurance they have, they can keep it. Millions of people will find that isn't the case because of the excise tax. It is going to be political suicide--probably even more damaging than the mandate to buy private insurance.

Join the Iowa progressive community at Bleeding Heartland.

Bad choice (4.00 / 2)
The House is taxing individuals making $500,000 per year and couples making $1 million or more per year.  The Senate is taxing middle class and working class people.  Or simply taking the good insurance away so the corporations make even more money.

The Senate bill looks like the worst of the Republican methods.  And we are doing this for one creep, Ben * Nelson.

This does not fly or even come close.


[ Parent ]
Its definately the biggest gamble... (0.00 / 0)
I mean if it suceeds in what its aim is, which is to force employers to negotiate or shop around for the best plans without going over the tax while trying not to upset the workers, it will potentially drive prices lower.   However, the gamble is if it fails to do this, it is politically damaging.   I like the rich tax better... most people are pissed at the rich anyway... I can understand the reasoning behind the excise tax and in theory its not bad, but the risk reward is too high for me.    

[ Parent ]
This is good analysis, yitbos96bb (0.00 / 0)
And it really exposes the neoliberal-social dem divide, as well as the employer-based health care system.  The problem with "competition" in the employer-based health insurance system, is that there is a gaping divide between the consumers of health insurance (those who buy the policies - the employers in this case) and the consumers of health care (those who have to USE the policies).  The end-consumers don't get to choose.

The neoliberal solution (excise tax) looks to help the employers to force reductions in total cost of health care by taking it out of the hide of the employees.  It "bends the cost curve" by making the consumers of health care make do with less.  The only costs they are looking at are the costs to government, not the costs to consumers, which will rise for certain relative to the levels of care that will be provided to them.

And the CBO (neoliberal firewall par excellence) is there to bless this approach.

The problem for the neoliberals here is politics.  The consumers still have a vote.  The fight between the funding base of the Democratic party and its voting base may be about to break out again over this.

The neoliberal approach (and its supporters here) like to point to the theoretical unfairness of making those without employer-provided health insurance pay for insurance with after-tax dollars, while those with it pay with pre-tax dollars.  I think that those who are sincere about this envision that this attack on employer-provided health care will eventually make it go away.  But all the politics cuts the other way.  We are strengthening the private insurance system and worsening the deal for the consumers.

Those advocating going along with the neoliberal approach here should explain why they think the long-term theoretical advantages of such a plan trump the short-term political objections to it.

There will be a Republican effort to repeal the entire plan.  It may succeed.  Why would even neoliberal Democrats go out of their way to help them?


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


[ Parent ]
union-employeer negotiated plans (0.00 / 0)
Whial unfamiliar with single employeer plans, I sat on two different health and accident trusts negotiated into multi employeer plans. One as a trustee the other (that the first was joined into) as advisory trustee. Both trusts were set up in the different labor contracts the employeers organization negotiated with the various local unions. Identical language and funding amount in each, one statewide the successor multistate.

In the trust (consisting of equal numbers employeer and labor representatives) majority rules. The natural distrust between management and labor make all trust issues/matters well investiagated prior to action. When in session, all trustees did the trusts business ONLY, leaving their respective sides of the occupational differences outside the room.

As a rule, the trustees are also negotiators of the contracts as well as the grievance committe.

Rest assured, in this enviroment, we solicited bids from different insurers, and their representatives had to negotiate with seasoned, effective negotatiors to be considered for the annual or two year contract.

We always got the best deal we could, and I personally never met an insurance rep that was in the same league as the trustees at negotation.

Government by organized money is just as dangerous as government by organized mob..... FDR


[ Parent ]
neoliberal dependence on market competition (4.00 / 2)
As Ed Kilgore astutely noted, the divide among the center-left over the health care bill is, and has always been, between:

* Centrists / Third Way / neoliberals who favor expanding health insurance through regulated and subsidized private providers,
and

* Left / liberals / progressives who favor expanding health insurance through public providers

If this is the central ideological battle among Democrats--and I have never seen a better analysis arguing otherwise--then the public option fight always encompassed more than just the creation of a new public health insurance program.  It included Medicare, Medicaid, CHIP, community health centers, the CLASS act, and more.

you are missing the neoliberal dependence on the magic of "market competition" even in cases, like health insurance, where it leads to a race to the bottom instead of optimizing outcomes.


re CLASS act -- need to read the CMS report (not just the CBO report) (0.00 / 0)
from arodb's diary at fdl: CLASS Program demonstrates dishonesty of Health Care Reform Bills

Compare this with the actuarial report from CMS
(pg 11)

In general, voluntary, unsubsidized, and non-underwritten insurance programs such as CLASS face a significant risk of failure as a result of adverse selection by participants. Individuals with health problems wold be more likely to participate than those in better than average health.....a classic "assessment spiral" or "insurance death spiral" ......there is significant risk that the problem of adverse selection would make the CLASS program unsustainable.

The CBO ignores the fact that this program is required to stand alone, precluded from being subsidized by federal funds. In this way it is similar to the same requirement of the "public option" for general health insurance. Yet, the CBO scores the revenue from premiums that should be treated as reserves as reducing the deficit, and then dismisses the anticipated cost when payments to subscribers will be due as "fairly small compared with the effects of the bill's other provisions." This enables them to ignore the ultimate actuarial inconsistency, and the specific requirement in the bill that this title be evaluated independently.

In contrast the CMS actuarial report describes the program for what it is, "a classic insurance death spiral" open to "adverse selection" that would make the CLASS program unsustainable without breaching the stricture of the program standing on its own

i recommend reading both CMS reports (for the current house and senate bills) and they are really good. especially compared to the CBO reports (i've read those reports too -- although not all of the bills themselves, that was too much).


i am in favor of universal single payer. does that make me (4.00 / 5)
a socialist? i know i'm not welcome in the democratic party anymore because of it.

the senate version of the bill really sucks. but seeing as there's still "more time," i'm sure a few more crumbs will be tossed our way to placate us into accepting this big gift to the insurance and for profit health care system. people are going to hate this thing when it's all said and done, barring a miracle that causes the critters to suddenly wise up and realize just what they're really going to do with this bill. but that's not going to happen, there's too many hookers and too much blow in the Village for clear thought.

atrios is right to call it "the democratic party mutual suicide pact of 2009." next year, and '12, are going to be so interesting. i can say that, as i pretty much don't care about the democratic party anymore. i am sorry to say that, but as the nutjobs like to say, "i didn't leave it, it left me." or maybe i should say, "it went right of me."  


What ideological battle? (4.00 / 3)
At long last, can we put to rest the notion that there was some principled opposition to the public option or Medicare buy-in?  

There was no principled opposition.  There was just a couple of hundred million dollars in lobbying money buying off meaningful reform.  The "center-left" wasn't fighting for "expanding health insurance through regulated and subsidized private providers."  If they were, they would have fought for some Swiss or Japanese-style reform.  No, they were just fighting for industry profits. Period.

Liberals are guaranteed to get their asses kicked as long as they concede that their opponents have some principled basis for their opposition.  When warranted, liberals need to attack their opponents motivations relentlessly.

As a reminder, Gingrich didn't lose his budget battle with Clinton by threatening to shut down the government.  He lost because he threatened to shut down the government out of spite for being forced to sit in the back of Air Force One.  Once his motivations were revealed to be frivolous, his support evaporated.


Finally, a non-flippant answer to my query! (0.00 / 0)
The question: here

The answer:

In exchange for his vote on cloture, Senator Bernie Sanders secured funding in the Senate bill that will double the number of community health centers in America:

Surely, the other Dem Sens got something, too?


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


Jeffrey Feldman's post on "corporatism" (4.00 / 1)
I'll be interviewing Jeffrey today at noon on blogtalkradio.  

http://www.blogtalkradio.com/n...  


For the "We can fix it later" bunch: (0.00 / 0)
Please name one piece of really shitty legislation--SINCE THE PRO-BIDNESS COUP OF 1980--to which the Congress has actually returned, and which was improved thereby, in terms of equity, fairness, or justice. One will do...

Mandates (0.00 / 0)
I'm surprised the GOP is so strong for the mandates in HCR.  They are so vehemently anti-gay...  ;)

I get the idea behind the mandates and I support it in principle.  But here's the rub and why I won't support the bill with mandates.  The money goes to the same companies who have already failed in health care insurance provision.  Why feed them more?

Either my money goes to a new entity for my demographic (40-something; public option, medicare, etc.) or we should just force all insurance companies to become non-profit.  Or perhaps we add in a clause where the mandate expenses to consumers are lower/subsidized if they choose a non-profit provider.  


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