16M low-income Americans receiving public health insurance is a progressive accomplishment

by: Chris Bowers

Fri Mar 26, 2010 at 12:43


You won't find me claiming that the health reforms that passed into law this week are great triumphs over corporate interests.  Also, I agree with David Dayen that the student loan reforms that passed into law this week are clearer-cut victory for progressives than the health reform bill.  Those reforms they effectively nationalize the student loan industry, by cancelling tens of billions in public subsidies to private student loan companies and replacing them with a student loan public option.

However, the claim that there is nothing progressive about the health insurance reforms that passed into law doesn't add up.  Because of this legislation, it is estimated that 16,000,000 additional low-income Americans will receive public health insurance than they would have under previous law (CBO report, PDF, page 21).  Millions of low-income, uninsured Americans received public health insurance is a straight-up, undeniable progressive victory.

Further, by moving much more of the cost of Medicaid to the federal level, the program becomes much more stable, and difficult for right-wing state governments to cut, over the long-term.

Yet further, the $11 billion in additional funding, over five years, for Community Health Centers in the legislation will, at current rates of service, provide primary health care to an additional 17.8 million low-income patients a year. (Current funding of $2.5 million a year (PDF, page 6) treats 20.27 million patients, so funding of $4.7 billion annually projects to 38.11 patients).

It can be reasonably argued that giving private health insurance companies an estimated 16,000,000 to 21,000,000 new customers in the health insurance exchanges (24,000,000 minus the 3,000,000 people who will drop off private employer insurance, minus some of the 5,000,000 people who will drop off non-group / other insurance) is not a progressive victory.  Also, the setbacks from reproductive rights, and the deals for drug companies, completely  stink.  However, it takes a pretty contorted argument, with a very odd definition of progressive, to deny that getting 16,000,000 additional low-income Americans public health insurance, and nearly 18,000,000 additional low-income Americans public health care, is not a big progressive victory.

Chris Bowers :: 16M low-income Americans receiving public health insurance is a progressive accomplishment

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16M low-income Americans receiving public health insurance is a progressive accomplishment | 78 comments
I agree. It is a net good, (4.00 / 2)
which is why I supported passing and fixing the senate bill through reconciliation. It is a moderate bill, but there are progresisve aspects.  And if nothing else, seeing the Republcians froth at the mouth over it is fun.

I also think its importantce is ideological.

http://www.dailykos.com/story/...

I wrote this diary originally in August 2008, the day after Barack Obama's DNC acceptance speech.  I republish it today because I think the health care bill he signed, while important in and of itself because it will help people, and because it will lessen some economic inequality in America, has even more symbolic importance in the realm of ideas, a realm dominated by Reaganite selfishness for almost 30 years.  
 

Good post, Chris.

An ideological victory for what? (4.00 / 7)
neoliberalism? centrism? corporatism?

How can a "moderate," corporate-friendly bill be a victory for progressivism?

[ Parent ]
16 million. 16 million. (4.00 / 1)
Sixteen. Million.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky
[ Parent ]
That has nothing to do with ideology (4.00 / 3)
As I said below, the GOP prescription drug benefit has helped lots of people too. Moderate Republican programs can help people too.  
[ Parent ]
16 nillion low income people getting health insurance is my ideology. (4.00 / 1)


--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky
[ Parent ]
Vacuous (4.00 / 2)

[ Parent ]
And shallow and stupid too. I dont have very good skills, nor do I want to be liked. (0.00 / 0)
But 16 million low income people insured.
Priceless.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky
[ Parent ]
No, it's not fucking priceless (4.00 / 4)
Millions and millions more people are going to be forced into a choice of either buying junk insurance from crooked monopolists, or having to pay the IRS a fine.

Biological drugs, which are needed for cancer treatment, will remain out of reach for many cancer victims for years to come because of this "progressive" bill.

That's not "Priceless" it's absurdly over-priced.

And the money for CHCs is chicken-feed. The whole damn bill is just not worth it.

[ Parent ]
no shit. (0.00 / 0)
and so, as I have said before, since its morally repugnant, and it is, lets open medicare to being funded by the federal insurance buying subsidy, so that our medicare system can be funded, and then it will be priceless.

I have had a point scored on me! I will have to wash this shirt and get the paint ball paint out of it. I've never had to get paint  ball paint out of my cloths before, I think I am just not made for that kind of sport.

Do I lie down now?

And the money for CHCs is chicken-feed. chicken feed? really?

chicken feed?

Does anyone actually think is good "attack from the left", "make me do it" kind of stuff? This is it?


--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky

[ Parent ]
Lol, that's not an ideology (4.00 / 4)
that's a result of a law that could be anything ideologically.  Conservatives want that same thing too, mostly on their own through the private sector.

If you say, okay well I want it done through the public sector, then you're expressing a liberal ideological preference.  And you have no argument from me here on Medicaid expansion.  Yay, more people on Medicaid!  That's terrific.  But one has to look at the larger context of the law.  That 16 million more on Medicaid comes at the price of the entrenchment of private health insurance companies.  And that's ideologically conservative and corporatist, not liberal.

[ Parent ]
are those numbers symbolic? (0.00 / 0)


"It sounds wrong...
     ...but its right."
[ Parent ]
16 million people could have been helped (4.00 / 5)
without enacting corporate giveaway legislation, reducing benefits for people who have good coverage now or requiring people to purchase overpriced products. In fact, by adopting just 3 proposals, millions more people would have been helped with a much smaller price tag.

1. Expand Medicaid as per current legislation
2. Budgeted $100 billion rather than $11 billion for Community Health Centers. Would have provided access to care for Medicaid/Medicare patients who are denied care because doctors /hospitals will not accept them as patients and provide actual health care for people without insurance.
3. Eliminate the overcharge by Pharma on dual eligible Medicare/Medicaid people. Would have closed the donut hole and provided $50 billion in revenue to offset the costs of the expanded Community Health Centers.


[ Parent ]
Lets get on it. (0.00 / 0)
1. Expand Medicaid as per current legislation

will do most of what we need on ending the venal portion of the mandate, fund Medicare, and save the budget.

Lets go, lets get on it.


--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky

[ Parent ]
Confused?? (0.00 / 0)
fund Medicare, and save the budget

This legislation substantially cuts the Medicare budget.

[ Parent ]
This legislation does not cut a single benefit to recipients. (0.00 / 0)
It has profit and cost reductions. And all those stipulations can be tweaked to increase service, which is a warning for constant vigilance, not in any way part of a reduction in service.

And no silly I'm not confused, we must raise more finds for Medicare. many ,mnay more finds, the Billions and Billions in subsidy funds would be a great start.

I hope I have your support to:

Save Medicare! Fund Medicare! Open Medicare to the Insurance Subsidy!

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky

[ Parent ]
While I would support Medicare for All (4.00 / 1)
or even having it as an option in the exchange, I do not think that I will see it in my lifetime. The industries have too strong a hold on all aspects of our government.

As for the current cuts not reducing benefits, technically that may be true. The cuts may well reduce access or the quality of care. Per the CBO report on the Senate bill:

http://cboblog.cbo.gov/?p=446

Based on the longer-term extrapolation, CBO expects that inflation-adjusted Medicare spending per beneficiary would increase at an average annual rate of less than 2 percent during the next two decades under the legislation--about half of the roughly 4 percent annual growth rate of the past two decades. It is unclear whether such a reduction in the growth rate could be achieved, and if so, whether it would be accomplished through greater efficiencies in the delivery of health care or would reduce access to care or diminish the quality of care.


[ Parent ]
As in yeah right. (0.00 / 0)
I agree that all government actions must be watched, I appreciate that in this matter as well, they must be watched. On the street level, in every facility and every state.

To throw this up as "proof" of "Cuts To Medicare (!!!)" is more than a little beyond ludicrous, however. In fact, with this "proof" I wonder why you would suggest it at all. Where do you get this stuff? What other web sites are peddling this nonsense?  

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky

[ Parent ]
Benefits without access to health care are worthless (0.00 / 0)
Example:

President Obama last year praised the Mayo Clinic as a "classic example" of how a health-care provider can offer "better outcomes" at lower cost. Then what should Americans think about the famous Minnesota medical center's decision to take fewer Medicare patients?
...
Specifically, Mayo said last week it will no longer accept Medicare patients at one of its primary care clinics in Arizona. Mayo said the decision is part of a two-year pilot program to determine if it should also drop Medicare patients at other facilities in Arizona, Florida and Minnesota, which serve more than 500,000 seniors.
http://online.wsj.com/article/...

None of benefits were cut but people on Medicare are being denied treatment or access to care by Mayo.  

[ Parent ]
Well I guess its like union negotiations. (0.00 / 0)
Only with corporations. Unlimited funding wont stop negotiation pressure tactics, and negotiating through global funding is bizarre and unproductive.

This happens everywhere. If 40% of patients are only available through Medicare, thats one heck of a lot of "business" to forgo.

I want savings built into the system, I want oversight to chart and insist on cost savings. I want advocates to chart and insist on patient rights and service provision.

Funding plans that dont track these things are immature and honestly should be illegal.

Personally I have long believed that .5 to 1% of all new budget allocations be allotted to 3 party audits to track outlay and transparency. I have no trouble remembering Bush's 6 foot high piles cash on pallets being put on planes headed for the middle east. Nor the republican congress that refused to even begin to try and track spending, bribery and theft.

I am not convinced.

I am also eager to see Community health clinics built down the block from some these "pilot closings" to see what the costs are.

Its our money, I want it used to provide services, not profit at all, and not much profit if it can't be helped, and most definitely not excessive profit.

First we have to have transparency, then accountability or every system becomes a feeding ground for the carpet baggers of healthcare. Just like Iraq became a feeding ground for Blackwater and the United Arab Emirate company Haliburton that Cheney used to be the exec with.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky

[ Parent ]
Um, "cost reductions?" That's a very polite way of saying doctors are (0.00 / 0)
going to get screwed. Which means that many more doctors will not be able to sustain their geriatrics practices. Which in turn assures that patients will have less access to care.
[ Parent ]
"doctors get screwed" (0.00 / 0)
I am going to have to insist on a little more evidence, and little more analysis.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky
[ Parent ]
David, ideas are not always related (0.00 / 0)
to substance.  

You fail to understand and we disagree on this.  So it goes.

[ Parent ]
What do I fail do understand? (4.00 / 3)
Are you saying that because it's because it premised on the idea of providing universal health insurance (although it doesn't, of course), it changes the discourse and pushes back again the Reagan legacy?

That may be, as far as it goes, but it doesn't go very far -- it goes about as far as an idealistic Obama speech in which he calls for peace, love, and understanding. What really matters, of course is the reality--the policy, what's being done and not done, and here, what's being done, is a neoliberal policy.  You--a critic of corporate neoliberalism--should know that better than most.

It seems to me that outspoken backers of the bill like you and Bowers defensively go out of your way to play up the good aspects. But hey, even Noam Chomsky said he probably would not have voted for the bill were he in Congress. It's a perfectly legit position to hold. No need to exaggerate its quality.  

[ Parent ]
They simply can't admit the truth (4.00 / 5)
Here's the deal you area right that these are right of center policies. But, they have to pretend that they are progressive. You are not going to convince them otherwise because unless it is one of the crazy right they no longer have the capacity to talk about it. There is no spectrum in politics. That's my view of part of the problem with the online discussion.  
[ Parent ]
Chomsky WOULD have voted for it (0.00 / 0)
[ Parent ]
The importantance of this "victory" is ideological. (4.00 / 6)
The Democratic president, Pelosi, the Democratic leader of the House, as well as numerous so called Progressives in the media (Ezra Klein) are simultaneously cheering this as a great victory while agreeing that this legislation mirrors conservative Republican proposals or "great ideas" of the past.

Indeed it is an ideological victory for those who support conservative Republican policies.  

[ Parent ]
I disagree. (0.00 / 0)
It is an ideological defeat for Republcians and conservatism.  You argument is too simplistic.  You fail to understand how ideas impact culture.  If this were so good, then the Rs would be cheering.  They were defeated and most people who fail to look at details see this is a victory for more governmeent over less.  
[ Parent ]
I used to hear these (4.00 / 5)
kinds of arguments to defend Clintonism. Hey, it's a defeat for Republicans and conservatism--must be progressive! Incoherent.

The reason the GOP isn't cheering is because the party's been taken over by the batshit right. Of course.

And of course corporate power is cheering. Generally, the cheers of corporations doens't equal progressive victory.

[ Parent ]
Wait what did Lenin say? (0.00 / 0)
"The cheers of corporations have nothing to do with their eventual defeat. Health insurance companies  will sell us the rope with which to hang them."
http://www.nytimes.com/1987/04/12/magazine/on-language.html?pagewanted=all

Oh yeah thats what Lenin said.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky

[ Parent ]
I disagree (3.00 / 4)
IMO your argument is too simplistic. The Republicans are in a win/win situation. This legislation will not help the majority of people in the country get affordable "health care" and will in fact, penalized many who do have it now.

Think you made my point for me in this

people who fail to look at details see this is a victory for more governmeent over less.

You can't bet your bottom dollar that every increase by the health industries will be blamed on the current legislation. When the majority of people continue to pay more and more for less actual care and the cost of premiums and prescription drugs continue to skyrocket, who will be blamed? The Republicans who voted against this bill or the Democrats who have "forced" them into more government involvement into health insurance.  

[ Parent ]
This is just one of the first examples of (4.00 / 1)
what I am talking about.

YORK (AP) - AT&T Inc. will take a $1 billion non-cash charge in the first quarter because of the health care overhaul and may cut benefits it offers to current and retired workers.

The charge is the largest disclosed so far. Earlier this week, AK Steel Corp., Caterpillar Inc., Deere & Co. and Valero Energy announced similar accounting charges, saying the health care law that President Barack Obama signed Tuesday will raise their expenses.
...
AT&T said Friday that the charge reflects changes to how Medicare subsidies are taxed. Companies say the health care overhaul will require them to start paying taxes next year on a subsidy they receive for retiree drug coverage.

The telecommunications company also said it is looking into changing the health care benefits it offers because of the new law. Analysts say retirees could lose the prescription drug coverage provided by their former employers as a result of the overhaul.
http://my.earthlink.net/track?...


[ Parent ]
Its theft. They are stealing, its a scam. AT&T needs law enforcement officials to investigate. (0.00 / 0)


--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky
[ Parent ]
Indeed. (0.00 / 0)
Thank you for all your work on this Chris.  I would just like to add just a little bit.

Just today, I overheard someone saying they were losing their job.  That is sad news, but I was thinking at the same time, because of what we have accomplished this week, that person won't have to worry about whether she can afford to take her kids to the doctor if they get sick.

I defy someone to tell me that helping that woman and millions more like her is not a something a liberal (or progressive) should be proud of.

Thanks to this bill, people don't have to worry about losing their health care if they lose their job.  That is change we can believe in.

We PTDB! Now, let's pass Grayson's Public Option Act!

Can I ask exactly how that's going to work? (0.00 / 0)
Once the new system is fully in place, employer-based health insurance will still be the norm for people with jobs.

So, let's say you have insurance through your employer, and you get laid off or fired.  Do you still get to COBRA your coverage?  If so, do the subsidies apply to your payments?  Do you enter the exchange to shop for an individual plan with subsidies based on your income?  Would Medicaid expansion apply to you, since you're now jobless?

[ Parent ]
Post-2014 (4.00 / 1)
COBRA coverage will be replaced by the exchange, where people will receive generous subsidies to help them afford a regulated insurance plan.  My reading of the bill is that after one loses their job, they will eventually qualify for medicaid within a year, once their AGI drops below a certain number.  I am not 100% sure on this point.

Pre-2014, people whose COBRA runs out will qualify for the high risk pool.

We PTDB! Now, let's pass Grayson's Public Option Act!

[ Parent ]
Obviously that's better than "tough shit" (4.00 / 2)
but that sounds like a mess, to be perfectly frank.  If the system were designed to just end employer-based insurance (and IIRC that was the basis of the Wyden plan, which I didn't like at the time but might actually be preferable to what just passed), then losing your job wouldn't interrupt your health insurance any more than it interrupted your kids' public school attendance.  But it sounds as if losing your job, once the system is in place, would involve switching insurers, and might involve getting worse coverage, since you might end up having to get a Bronze plan, which would be worse than what you had at your job.  And then after switching to the exchange plan, you might end up qualifying for Medicaid.

If insurance is all essentially the same, then this isn't a big deal.  But if each insurer has its own network, and different plans have different copays and deductibles, it will matter.

For now, though, it's water under the bridge.  No one is going to touch these kinds of details until the system is up and running and people are having problems with it, and that won't happen for 5 or 6 years, at least.

[ Parent ]
A strong improvement on the status quo. (4.00 / 1)
I'm not saying the system is perfect, but unless you do terminate all employer-based insurance (not viable politically), this is the type of system you are going to end up with.

One way of looking at it is this.  The way this law is structured, only those who lose their jobs will have to worry about switching their insurance plans in the exchange.  If we were to completely end employer based insurance, everyone would have to make a switch, job loss or not.

Losing your job will still be a bummer, but at least there is a health care safety net now, one that doesn't involve bankrupting your family.

We PTDB! Now, let's pass Grayson's Public Option Act!

[ Parent ]
Are you arguing against Medicare for All when you say this (4.00 / 1)
If we were to completely end employer based insurance, everyone would have to make a switch, job loss or not.

I'm not sure what your point is here.

[ Parent ]
This logical fallacy keeps popping up (4.00 / 7)
This bill helps people, therefore it must be "progressive."

By this standard, the GOP's prescription drug benefit bill was "progressive" because people benefited. How could Ted Kennedy and other liberals deny people lifesaving medication by opposing the bill!!


[ Parent ]
Whatever. (0.00 / 0)
I'm sick of these red-herring arguments re: Medicare Part D.

The main reason why GWB's reform sucked was because it was designed to privatize and weaken Medicare through Medicare "Advantage" subsidies (Part C).  They coopted a progressive issue to push their ideological hatred of Medicare.  Without that fact (and that it wasn't paid for) it might have been worth supporting, even if it isn't a bill I would have written.

So no, weakening Medicare is not a progressive victory.  However, "Obamacare" does the opposite, strengthening Medicare.

We PTDB! Now, let's pass Grayson's Public Option Act!

[ Parent ]
But it helped people! (4.00 / 5)
I can't believe you would have denied lifesaving medication to people.
[ Parent ]
It has seriously harmed Medicare. (0.00 / 0)
Besides, it's not like it was the only alternative.  Failure would have forced Bush to cut a deal with Democrats if he didn't want to reap the consequences of failure.

Would we have been better off forcing Obama to cut a deal with Republicans on this bill?  What would that deal have looked like?  What would it have meant for future reforms?

We PTDB! Now, let's pass Grayson's Public Option Act!

[ Parent ]
The alternative could've easily been nothing (4.00 / 1)
GWB could've easily shrugged and done nothing more than say, "well I tried and Democrats obstructed me.  Vote for Republicans in 2004."  There's no compassionate bone in his body compelling him to do some kind of prescription drug benefit.

And then the lives of all the seniors that needed those drugs would be on the hands of everyone who was against that benefit, including you and me.  Can you live with that?

[ Parent ]
By the way (4.00 / 1)
You just made a real argument, I don't agree with it but it's a genuine argument for the bill's progressivism. To say that the bill is progressive because it helps people is, as I said, silliness.  
[ Parent ]
Over the last decade we have been taught online that (4.00 / 1)
Republican ideas never ever help people. So it is impossible to believe that now.  
[ Parent ]
It's about results. (0.00 / 0)
Getting health care for middle class people has been a progressive goal for decades.

You are misrepresenting one of my justifications for the law and portraying it as the entirety of my argument.

I never said the bill is progressive "because it helps people."  I said progressives should be proud because it helps people.  I view it as a progressive bill, because we are better off under this bill than we would be without it.  I weigh a variety of factors to come to this conclusion.  The fact that it helps unemployed Americans is one of those factors.

That woman who lost her job is better off after these reforms.  So forgive me if I am proud of my small role in helping her.

We PTDB! Now, let's pass Grayson's Public Option Act!

[ Parent ]
Exactly (4.00 / 5)
Just as they've adopted the "progressive" issue of expanding Medicaid to enshrine and strengthen the private insurance regime we have.  
[ Parent ]
Wrong. (0.00 / 0)
Bush took the issue of prescription drug costs and used it as cover to weaken medicare.

No one was campaigning that we need to reform health care solely through medicaid expansion.  It's not a comparable situation.

We PTDB! Now, let's pass Grayson's Public Option Act!

[ Parent ]
But some people are using Medicaid expansion and some other stuff like no denials for preexisting conditions (0.00 / 0)
to try to mask the sight and smell of odious corporatist giveaways, chiefly the individual mandate.  Perhaps that's why the mandate is never mentioned in this deluge of OFA/DSCC/DCCC emails I've been getting.

To me it's like trying to cover a mound of steaming horse shit by sticking a paper saying "There's no shit here!" to it.  It doesn't work on me but it's working on a lot of "liberals", probably because they either are unaware of the mandate (and who can blame them?  They're not hearing about it from the Great Hope Guy) or haven't thought through as to how much of a corporate giveaway it is.  Or maybe we're so corporate-dominated that they have and they still don't care.  That'd be really sad.

[ Parent ]
Guffaws (4.00 / 3)
I find this amusing because the similarity between Obamacare and Medicare Part D was the deciding reason for my opposition to Obamacare.

Both laws provide a "benefit" by basically throwing a lot of money at already powerful insurance companies and hoping they'll do a good job, rather than by expanding the public sector.  Just as 2003 Medicare was "designed to privatize and weaken Medicare through Medicare 'Advantage' subsidies", 2010 Obamacare is designed to privatize our health insurance sector through subsidies to private for-profit insurance.  Except Obamacare tops that by adding a mandate and giving those insurance companies a captive market, thus nearly-permanently entrenching those bloodsuckers into the very fabric of our daily lives.  Even Medicare Part D didn't go that far - AFAIK participation is voluntary.

That's why I've been going around for the last several months and asking every pass-the-biller on Open Left if they would've voted for 2003 Medicare.  I wasn't doing it to be annoying, even if it may have come off that way.  I was doing it because I felt that Obamacare was a very similar "feed the corporations so they'll feed the people" approach to what the Republicans backed, and Democrats opposed, back in 2003.  So I was wondering if anyone else felt the same way, and if they did, how would they reconcile their opposition to what the Republicans did back then with what Democrats are doing right now.

And just as Republicans "coopted a progressive issue to push their ideological hatred of Medicare," Obama and other corporatist Democrats coopted a progressive issue to push their ideological hatred (or snooty disdain, perhaps) of single-payer.  Because no one's explained to me how this law makes it easier to get there.  In fact, I think if anything it makes it harder.

[ Parent ]
Yeah (4.00 / 6)
the claim that there is nothing progressive about the health insurance reforms that passed into law doesn't add up.

But who's making that claim. Links?

Most people making silly claims about the bill are exaggerating its awesomeness. Chait:

What has emerged from that machinery is not merely "better than nothing" or "a good start." It is the most significant American legislative triumph in at least four decades.

http://www.tnr.com/article/pol...

He tries to square this grandiose claim with his acknowledgement that this is "a moderate Republican bill."

You can fairly call in moderate Republican, or neoliberal. You can't call it a progressive bill, a truth even some of its supporters now acknowledge:

Ezra Klein:

This bill is Clintonian: It achieves liberal ends through market means, and since conservatives frequently claim they are also in favor of access to medical care, it's not even clear that near-universal coverage can properly be called a liberal end. Not to mention that it's more conservative than the Great Triangulator himself was: It doesn't resemble his reforms so much as the Republican alternative to his reforms.

http://voices.washingtonpost.c...

And that's precisely what critics are saying, that it's fundamentally centrist, progressives elements notwithstanding. No one that I see is denying that the bill contains some progressive elements.


The mandates are moderate/center-right. (0.00 / 0)
The Medicaid expansion is liberal, as is the scope of the subsidies. I was surprised it was Snowe, of all people, who got the subsidies up to their current level. I suppose you could argue that the mandates wouldn't fly without subsidies of roughly the current level, so a rational center-right moderate pushing the mandates might have to push for such subsidies (and perhaps that was Snowe's motivation), but I haven't seen that kind of thing in the saner right-leaning proposals.
[ Parent ]
Not quite (4.00 / 6)
I'd agree with you on Medicaid expansion, not on subsidies, which aren't sufficient enough to be called progressive.

In any case, the important thing is what the bill is at its core: it's a market based "solution." with billions of dollars going to corporations and relatively tiny gains for public insurance. I knew very little about health policy and was surprised to learn how much Obama's plan resembled Republicans proposals. Jonathan Chait:

Obama's plan closely mirrors three proposals that have attracted the support of Republicans who reside within their party's mainstream: The first is the 1993 Senate Republican health plan, which is compared with Obama's plan here, with the similarity endorsed by former Republican Senator Dave Durenberger here. The second is the Bipartisan Policy Center plan, endorsed by Bob Dole, Howard baker, George Mitchell and Tom Daschle, which is compared to Obama's plan here. And the third, of course, is Mitt Romney's Massachusetts plan, which was crafted by the same economist who helped create Obama's plan, and which is rhetorically indistinguishable from Obama's.

http://www.tnr.com/blog/jonath...

[ Parent ]
Maybe enacting moderate Republican ideas (0.00 / 0)
of the 1970s are progressive victories today, just like the extremist John Birch ideas of the 1970s are the mainstream conservative ideas of today?

In any case, I think we're getting hung up on definition--not just of 'progressive' (which some take to mean, 'anything that progresses us in a better direction'), but of 'accomplishment.' Enacting a moderate Republican idea can be a progressive accomplishment if the alternative is a far-right Republican idea.

[ Parent ]
No (4.00 / 7)
Labeling is tiresome and imperfect, but liberalism has a meaning, and that meaning simply can't apply to a market-based approach that further enriches corporations. That doesn't mean it's awful. It's just makes it not progressive.  
[ Parent ]
Distorting that meaning also makes future battles harder (4.00 / 3)
That was the lesson of Clintonism. To move the definitions of words to the right, favors conservatives in later battles. The best solution strategically is to call it conservative.
[ Parent ]
Well, progressive has (0.00 / 0)
a meaning, and that given that progress was made, by that definition this law is progressive.

And also, a liberal accomplishment and liberalism aren't necessarily the same thing.  

[ Parent ]
Bill Clinton was, by your definition, a progressive (4.00 / 4)
Obamism induces quite a bit of post-modern truth-denying. There are no objective truths, terms don't mean what we used to understand they meant, terms don't really mean anything, etc.  
[ Parent ]
And we're not talking (4.00 / 2)
about GOP ideas from the seventies but from the nineties and more recently: Romney's plan.  
[ Parent ]
Ah yes. Moral relativism. (4.00 / 2)
How far we have fallen.

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 ]
In fairness many of them probably came of age (0.00 / 0)
under Clinton and Bush were moral relativism was triumphant. It is not a surprise they can't imagine a world in which you don't just make shit up as you go and claim that whatever you change the definition to in the heat of an argument does not mean that's actually the definition. The thing that I keep being reminded of is this is what Dems and GOP share at this point, and it always moves the ball right rather than left.  
[ Parent ]
Physicians for a National Health Program statement (4.00 / 7)
Chris, I have followed with interest your posts as this process has unfolded, and I wouldn't disagree that there are good things in the bill. However, we should listen to the voices of those on the front line within our broken health care system. Right now is a dangerous time, as focus moves away from the issue. If progressives don't bring strong attention to the deficiencies of the bill and urge efforts to correct them, the continued suffering of millions, both before and after implementation in 2014, will go off the radar screen. I find the PNHP analysis very compelling. They and Dr. Marcia Angell sound alarms that we ignore at our peril, I think. Here is an excerpt from their statement post bill passage.

"As much as we would like to join the celebration of the House's passage of the health bill last night, in good conscience we cannot. We take no comfort in seeing aspirin dispensed for the treatment of cancer.

* About 23 million people will remain uninsured nine years out. That figure translates into an estimated 23,000 unnecessary deaths annually and an incalculable toll of suffering.

* Millions of middle-income people will be pressured to buy commercial health insurance policies costing up to 9.5 percent of their income but covering an average of only 70 percent of their medical expenses, potentially leaving them vulnerable to financial ruin if they become seriously ill. Many will find such policies too expensive to afford or, if they do buy them, too expensive to use because of the high co-pays and deductibles.

* Insurance firms will be handed at least $447 billion in taxpayer money to subsidize the purchase of their shoddy products. This money will enhance their financial and political power, and with it their ability to block future reform.

* The bill will drain about $40 billion from Medicare payments to safety-net hospitals, threatening the care of the tens of millions who will remain uninsured.

* People with employer-based coverage will be locked into their plan's limited network of providers, face ever-rising costs and erosion of their health benefits. Many, even most, will eventually face steep taxes on their benefits as the cost of insurance grows.

* Health care costs will continue to skyrocket, as the experience with the Massachusetts plan (after which this bill is patterned) amply demonstrates.

* The much-vaunted insurance regulations--e.g. ending denials on the basis of pre-existing conditions--are riddled with loopholes, thanks to the central role that insurers played in crafting the legislation. Older people can be charged up to three times more than their younger counterparts, and large companies with a predominantly female workforce can be charged higher gender-based rates at least until 2017.

* Women's reproductive rights will be further eroded, thanks to the burdensome segregation of insurance funds for abortion and for all other medical services.

It didn't have to be like this. Whatever salutary measures are contained in this bill, e.g. additional funding for community health centers, could have been enacted on a stand-alone basis.

Similarly, the expansion of Medicaid--a woefully underfunded program that provides substandard care for the poor--could have been done separately, along with an increase in federal appropriations to upgrade its quality.

But instead the Congress and the Obama administration have saddled Americans with an expensive package of onerous individual mandates, new taxes on workers' health plans, countless sweetheart deals with the insurers and Big Pharma, and a perpetuation of the fragmented, dysfunctional, and unsustainable system that is taking such a heavy toll on our health and economy today.

This bill's passage reflects political considerations, not sound health policy. As physicians, we cannot accept this inversion of priorities. We seek evidence-based remedies that will truly help our patients, not placebos.

A genuine remedy is in plain sight. Sooner rather than later, our nation will have to adopt a single-payer national health insurance program, an improved Medicare for all. Only a single-payer plan can assure truly universal, comprehensive and affordable care to all.

By replacing the private insurers with a streamlined system of public financing, our nation could save $400 billion annually in unnecessary, wasteful administrative costs. That's enough to cover all the uninsured and to upgrade everyone else's coverage without having to increase overall U.S. health spending by one penny.

Moreover, only a single-payer system offers effective tools for cost control like bulk purchasing, negotiated fees, global hospital budgeting and capital planning.

Polls show nearly two-thirds of the public supports such an approach, and a recent survey shows 59 percent of U.S. physicians support government action to establish national health insurance. All that is required to achieve it is the political will.

The major provisions of the present bill do not go into effect until 2014. Although we will be counseled to "wait and see" how this reform plays out, we cannot wait, nor can our patients. The stakes are too high."

I agree that we must stay at work repairing health insurance, and health provision. (0.00 / 0)
And health too.

The parts of the Bill that make no co-pays for preventive care will help a lot.

But we must demand and get, organize for and scream for: letting federal subsidy monies that are paid to insurance companies, ALSO be allowed to paid into Medicare. medicare needs funding, let the Billions and Billions of subsidy dollars be paid into Medicare. Save Medicare, Fund Medicare, Open Medicare to funding by the American people.

Let America buiy into Medicare, let our subsidies support Medicare!

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky

[ Parent ]
I disagree with subsidies for Medicare (4.00 / 2)
because over the long term the Cadillac tax becomes the main revenue stream for the subsidies. The Cadillac tax is not progressive, in the sense that upwards of 80% falls on the middle class. Medicare should be funded in a progressive fashion through a payroll tax with no cap.
[ Parent ]
HCR (4.00 / 1)
More koolaid
Thank you for your flag waving. (0.00 / 0)


--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky
[ Parent ]
Chris, you can add to your argument that the primary funding mechanisms (0.00 / 0)
for the subsidies and for the Medicaid expansion are:

1) the expansion of the Medicare payroll tax to all earned income over $250,000 per year, and all unearned income (investments, capital gains, etc) received by people earning more than $250,000 per year, and

2) cuts to the Medicare Advantage program, which was a giveaway to these same insurance companies.

One could figure, roughly, that we taxed the rich to pay for the Medicaid expansion, and that we took from the insurance companies to fund the subsidies that go back to the insurance companies.

It is still true that middle class people who were uninsured are now mandated to give money to insurance companies in exchange for health insurance.  But, NEWSFLASH, that's what 90% of the middle class has been doing all along anyways.  Almost all of us have been giving money to insurance companies in exchange for kindof shitty coverage already.  Now everyone can (and must), and there are subsidies to help you if you can't, and there are regulations to rationalize the individual and small-business market, and to stop the horrendous abuses like pre-existing condition and recission.

It's true that this is not a radical health care overhaul.  It just mends the existing, not-great system, such that fewer people are left out of it entirely, or actively screwed by it.  But as long as we needed 60 votes in the Senate and we have the existing Democratic Party as we know it, that was all we were really able to get.

The most rapid route to progressive change at this point is the elimination of the 60-vote rule.  With a 50-vote requirement it becomes possible to pass significantly more progressive legislation.  It also becomes possible for the GOP to pass significantly more regressive legislation in the future, but that's a deal we almost certainly have to take, as the status quo, total legislative stagnation, is also fundamentally conservative in its outcomes.

Despite the smoke and mirrors the Cadillac tax (4.00 / 1)
will eventually become the major revenue stream for the bill. It is the only funding mechanism that grows faster than medical inflation. More than 80% of the revenue comes from the middle class, a percentage that rises over time, so it is not progressive. On the other hand, the increase in the Medicare tax was something that would have happened anyway as part of any effort to "shore up" Medicare. It remains to be seen if that will be all that is asked of the rich, and if further Medicare reform will now be done on the backs of the middle class. If so, the rich got a very good deal.
[ Parent ]
fake reform via black agenda report (4.00 / 4)
The fifteen month running battle between Obama Democrats and tea party Republicans was never much more real than televised professional wrestling. Like the opposing wrestlers, both sides work for the same bosses, for Big Pharma, Big Insurance, and the biggest medical providers. The real health care fight waged by the Obama administration has not been against Republicans, who never had the votes to stop, let alone dictate or pass anything.

The administration's effort all along has been to pass the worst bill possible, with the greatest amounts of corporate welfare and loopholes, and the fewest protections for patients, while silencing, neutering and coercing the voices of most Democrats, who have favored some form of single payer, or Medicare For All from the beginning.


http://www.blackagendareport.c...

This was a progressive net loss.

LOL (0.00 / 0)


--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky
[ Parent ]
Let's ignore the substance. What's the strategic value of your argument (4.00 / 5)
going forward into the future now that the bill has passed?

Wouldn't the better argument, since everyone claims that further reform will need to happen, is to call this "Conservative"?

What do you think you have to gain by labeling a moderate bill as progressive?

On a strategic level, you seem to be shooting yourself in the foot. If you don't listen to anything else I say, learn how to play the definition game.

The Democratic establishment (not necessarily Chris) is using these liberal small potatoes on kill-the-bill liberals (4.00 / 1)
as a mother would use a pacifier on her wailing baby.  "Hush, little naive liberal, there's some good liberal stuff in the otherwise corporatist law.  Now be a good little obedient liberal and vote for Democrats this fall."

God forbid we actually be intelligent and see the law for what it is, and thus become dissatisfied and not vote for Democrats anymore.

Btw, in all the celebratory emails I've been getting from OFA/DSCC/DCCC, I never hear any mention of the individual mandate.

[ Parent ]
The GOP will bring the mandates up. And, I disagree about Chris. (0.00 / 0)
Sorry, but I don't see the point of reposting the same list of things he believes makes this bill progressive unless he is trying to framing the bill as such. He already got those victories, time to move on to something more. Hence my comment. I don't see the point unless one is, of course, trying to protect the Democratic Party rather than influence future policy.
[ Parent ]
The individual mandate (0.00 / 0)
is explained by Ezra here. You'd be interested to know that "it's the best deal in the bill." Also it "ensures that people aren't riding free on the system by letting society pay when they get hit by a bus."

Surely we can all agree that being forced to buy the corporate insurance product is a great deal. What I don't understand is why society shouldn't pay when someone is hit by a bus. It's not the victim's fault. It's not the middle class's fault. Yet this bill dumps all the responsibility on those two groups.

[ Parent ]
Thank you, but I already know all about the reasons for a mandate (4.00 / 4)
as I have since back in 2007 when we had the whole mandate debate.  While I did not support him in the primaries, on the issue of the mandate I was on the side of Barack Obama.  I'm glad to see that Obama maintained his steadfast opposition to the individual mandate and wasn't just pointlessly picking a fight to differentiate himself from Senator Clinton...

The bone I'm picking is not over the idea of government mandating citizens to do something; it's the idea of that mandate going to private, for-profit corporations, and the same ones that caused this whole problem to boot.  It just reinforces that broken system and as Cenk Uygur points out, it's going the wrong way.  If this isn't Big Corporatism, I don't know what is.

I was fine with the mandate as long as it came with the public option.  Those two things went hand-in-hand.  I didn't accept the idea that you could have a mandate without a public option; that's like having a carriage without a horse, or a car without a steering wheel.  And just like those things, a mandate isn't inherently "bad" but it becomes so if that other component isn't there, because it then becomes a corporate giveaway.  This is true regardless of how "good a deal" paying the fine might be.

Really, I don't know which is sadder - that we have a mandate with no public option, or that so many liberals were not only accepting of such a corporatist arrangement, but defending it.  To put it simply, it should NOT be our job to defend the most corporate-friendly parts of this law.

[ Parent ]
Here's John Shadegg again making the liberal/progressive case against the law (0.00 / 0)
here.

I don't know about anyone else here, but I think it's REALLY SAD that the one member of Congress who speaks and voted for me, is a far-right conservative Republican.

[ Parent ]
i just found out (4.00 / 2)
that because of the provisions in the bill that now insures children up to the age of 26 and no lifetime caps, our company is already in negotiations with the insurance company but we have been worned of significant increase comming our way.  
that will be happening all over (4.00 / 6)
and Democrats will be blamed.

Join the Iowa progressive community at Bleeding Heartland.
[ Parent ]
16M low-income Americans receiving public health insurance is a progressive accomplishment | 78 comments
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