The future of health care reform (after this attempt)

by: Adam Bink

Thu Jan 21, 2010 at 14:30


A blog post from Paul Krugman on potential for a better bill:

The Underpants Gnomes Theory Of Reform

Watching some liberal members of the House explain why they won't do what's necessary, and pass the Senate bill, I was wondering what they imagine will happen. Then the answer came to me: it's the Underpants Gnomes business plan. In its original form this was:

1. Collect underpants.
2. ?????
3. Profit!

The current version is:

1. Reject the only bill that can be enacted any time soon.
2. ?????
3. Universal coverage!

Sigh.

On the future of the issue it raises an interesting point. I think it was Ezra Klein who pointed out health care reform attempts come along I believe every 17.5 years (although maybe at the rate of things falling apart, the next chance will be sooner). But however long the time period, is the degree of how terrible the situation is regarding health care reform (number of uninsured, among other yardsticks) inversely proportional to the chance that progressives will get a better bill next time? Meaning, if you hold out and wait for things to get worse, are your chances for a better bill improved? Will a grassroots swell among the citizenry emerge in favor of single-payer, for example? Or will there be an even worse bill next time?

And how long will it actually take? On the one hand, as Chris argued here, we would have achieved a public option or Medicare buy-in had a few Senators not lied. So it is only a matter of ridding ourselves of a few bad apples to achieve an acceptable bill to those in the House currently refusing to support it. But you also need a supportive President and similar or better congressional majorities, and how long that takes, given that a shellacking appears likely this November, is anyone's guess. Alignment of all those stars is difficult.

Given all that, it seems to me the central point here is that the crystal ball is hazy, and you never know how long it will take to get the political dynamics all aligned again to take another shot. I can't find the comment link, but one of the strongest arguments I've seen in favor of passing the bill was by Mark Matson (who can correct me if I'm not paraphasing correctly) which is that if the bill became law in the future, no one would want to go back to the health care situation this country had in 2009. Given that the political future is hazy on when we'll get another shot, that seems worth keeping in mind as members of Congress consider whether it's worth banking on another shot in the future.
Adam Bink :: The future of health care reform (after this attempt)

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The future of health care reform (after this attempt) | 63 comments
Krugman is wrong on this. (4.00 / 1)
Passing a bad bill now in hopes that it will be improved later is a horrible precedent to set.  He and the Democrats should have learned that from failure to fix NAFTA, for example, after passing it for the sake of expediency.  If you can't get it right the first time, don't do it at all.  The results will be even worse.
Great, see you in 20 years. (4.00 / 2)

[ Parent ]
No me... (0.00 / 0)
I'll probably be dead by then due to lack of healthcare... Thanks, Naderites!!!

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!
[ Parent ]
Hmm... (0.00 / 0)
SO lets see...

We can have a system with escalating prices, with no price controls and leaves an insane number uninsured, PLUS allows the insurance companies to discriminate against or cancel coverage if they want....

OR

We can have a system with the potential of escalating prices, with some questionable price controls, 30 million MORE insured persons and the end to pre-existing conditions and recission...

YEAH, You're right... System 1 that screws more of the people and does nothing to help anyone IS the way to go [SNARK].    

[ Parent ]
If anything you said about the Senate Bill were true (4.00 / 2)
Most of us would agree with you.  But it doesn't achieve what you claim.  It allows unreasonable increases in price for pre-existing conditions and Wendell Potter has pointed out over and over that the insurance companies will have a many ways around the both exclusion and recision clauses.  And for that matter, who would enforce them.  The only thing this bill does is create a mandate to buy a policy of undescribed quality at any price the insurance company dictates and puts the state and federal governments on the hook for these price raises.  You are suggesting we should buy a bag of $hit and use it for fertilizer.  My feeling is that don't need another farm subsidy.
[ Parent ]
Did you support the 2003 prescription drug benefit law? (0.00 / 0)

[ Parent ]
no. (0.00 / 0)

[ Parent ]
re (4.00 / 1)
we would have achieved a public option or Medicare buy-in had a few Senators not lied

it's not so simple

say Feinstein didn't really want it
why say it when you have liberman, nelson, and lincoln?
why lose some democratic votes for saying 'I don't want' something that won't become reality

remember efca?

and now that the health insuranse companies (4.00 / 2)
can spend unlimited money in elections it's more difficult, right?

how opposed will they be at medicare at 50/55?

are those ages profitable or are people that need care tere?
weren't they ok with medicare at 65+ because 65+ is full of people that need more care?

[ Parent ]
What is really possible right now? (4.00 / 2)
That is the question that noone can safely answer. My guess is that if Obama really wants--deep in his soul--passionately wants some kind of health reform bill to pass, it will happen.

I'm not sure he cares.

I think he cares about that most elusive dream of all--a golden age of bipartisan collaboration.

Not gonna happen.

we can get a BETTER deal now (0.00 / 0)
this seems pretty clear. yoke the Senate bill as-is to a reconciliation vehicle that knocks down the excise tax, allows drug reimportation, fixes the exchanges, and adds a weak-tea "level playing field" public option. all of that can pass with 51 votes, and all of it is fair game for reconciliation (since all the rest of it is paying for the tax change).

this is an improvement! it's way better than whatever slight modifications could have gotten through 60 votes again in the Senate. the only thing i can figure is that nobody in the House believes the Senate will live up to their end of that deal. you can see where they might have gotten that idea. but i think it shouldn't stop them.

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

[ Parent ]
Hey, can I get in on that dream? (4.00 / 1)
Sounds pretty sweet, and we have tons of evidence pointing to the fact that Democrats have enough spine to totally make this possible.
[ Parent ]
fine, fine (0.00 / 0)
introduce realism, why don't you...

but seriously, i can't see why this isn't at least as possible as what they were contemplating pre-Brown.

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

[ Parent ]
It should be... (0.00 / 0)
And actually, I think the Senate would probably do it... The House won't do the work they need to on their end, though (which is to say, they need to vote for the Senate bill).
[ Parent ]
Selfish (0.00 / 0)
So many short sighted selfish people who only give a damn about their own premiums and don't really give two shits about the 30 million plus people who will get coverage with this, plus everyone who will be protected from recission and pre-existing conditions.   Selfish shortsighted people who have their heads up their asses and, as Krugman points out, seem to think some magical fairy will pass some super bill despite the fact that we haven't seen a 50 plus progressive majority in this country since the 60's.    40 plus years and counting... but YEAH, we'll have the Senate and Congress and President to pass truly progressive healthcare in one go at it... I'M SURE Single Payer is right around the corner [SNARK].

I'm so disgusted with so many people throughout the political spectrum right now.   Frankly, I'm starting to believe that between the arrogance of some, the greed and disdain of others and the outright stupidity of the rest, that we are pretty much reaping what we sow now.  

Sorry... agree with your post 10% Adam.   End Rant.

It's not even selfish.... (0.00 / 0)
These folk can lose their health coverage on a whim... it's in their best interest to support universal coverage!

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!
[ Parent ]
Well, those selfish people just took the 60th Senate seat away. (0.00 / 0)
Read the comments fom MA voters captured by the media! Many talk openly abpout the bill being a "giveaway". Face it, a bill that only cares for the uninsured, and provides only very questionable value for the other CAN'T be very popular. People simply aren't that altuistic (on average). Cutting away all parts that were interesting for the majoritywas a SEIOUS mistake. And it's Liarman who is responsible for that failure. He really should be tarred and feathered.

If the bill fails, give the uninsured his address!

[ Parent ]
I don't know about his home address (4.00 / 1)
But for those who are interested, here are addresses and phone/fax numbers for his CT and DC offices:

Connecticut Office
One Constitution Plaza
7th Floor
Hartford, CT 06103
860.549.8463 (Voice)
800.225.5605 (In CT)
866.317.2242 (Fax)

Washington DC Office
706 Hart Office Building
Washington, DC 20510
202.224.4041 (Voice)
202.224.9750 (Fax)

[ Parent ]
Did you support the 2003 prescription drug benefit law? (0.00 / 0)

[ Parent ]
no. (0.00 / 0)

[ Parent ]
A modest proposal (4.00 / 3)
From Wikipedia:

The nuclear option is used in response to a filibuster or other dilatory tactic. A senator makes a point of order calling for an immediate vote on the measure before the body, outlining what circumstances allow for this. The presiding officer of the Senate, usually the vice president of the United States or the president pro tempore, makes a parliamentary ruling upholding the senator's point of order. The Constitution is cited at this point, since otherwise the presiding officer is bound by precedent. A supporter of the filibuster may challenge the ruling by asking, "Is the decision of the Chair to stand as the judgment of the Senate?" This is referred to as "appealing from the Chair." An opponent of the filibuster will then move to table the appeal. As tabling is non-debatable, a vote is held immediately. A simple majority decides the issue. If the appeal is successfully tabled, then the presiding officer's ruling that the filibuster is unconstitutional is thereby upheld. Thus a simple majority is able to cut off debate, and the Senate moves to a vote on the substantive issue under consideration. The effect of the nuclear option is not limited to the single question under consideration, as it would be in a cloture vote. Rather, the nuclear option effects a change in the operational rules of the Senate, so that the filibuster or dilatory tactic would thereafter be barred by the new precedent.

Could we prevail on a Senator such as Franken to make such a point of order (on anything the Repugs are blocking, the underlying bill doesn't matter) so we can see how many votes we have to overturn the filibuster and which Senators we need to work on?

Get rid of the filibuster and we can actually pass the agenda Obama ran and was overwhelmingly elected on....

Howard Dean in 2016

I'd support it.... (4.00 / 1)
 But Reid is DEADSET against it, and without his support, I just don't see this happening.
[ Parent ]
is it on reid's hand? (4.00 / 2)
I thought one random senator makes the motion to biden and then you need 50?
[ Parent ]
Exactly. If Biden plays along. we don't need Reid. (0.00 / 0)
And Biden, btw, was in the media recently voicing his concern about the filibuster. He seems to be willing to do something against it. If a majority of the Senators play along is another question...
[ Parent ]
Reid finally realized the truth about Snowe (4.00 / 1)
Maybe he could be persuaded on this too....

Howard Dean in 2016
[ Parent ]
Failure (4.00 / 1)
Failure of imagination.

Failure of courage.

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

The reason the health bill failed (0.00 / 1)
Is because it lacks popular support. Its well acknowledged that the problem with healthcare is skyrocketing premiums. This bill does little to nothing to counter this. As a result, most people in this country do not stand to benefit. If anything, they get a mandate to buy health insurance, another big government maneuver with little direct benefit to most people in the united states.

As for universal coverage, its a worthy goal but the way current health care reform goes about it is guaranteed to be politically unpalatable: taxing and spending with a mandate. The way to attack this problem is actually to lower health care costs so that people can afford them, not subsidize it directly. But as I mentioned, there are little to no cost containment measures in this bill. The hard choice shouldn't really be who do we tax for this, its who do we squeeze to lower health costs.

Is it doctors? Is it hospitals? Is it insurance companies? Is it the citizens for using so much health care? Is it drug companies? Is it lawyers? Is it soda companies? Is it fast food?

So what we end up with is a trillion dollar bill paid for by taxes one way or another in an environment where we're running trillion dollar deficits and with little to no impact to most americans. Oh and did I mention you get a nice government mandate telling you that you must buy into this system?

Sometimes... (0.00 / 0)
You have to look past the selfish people and actually have the courage to help the rest.   But of course, most of congress is too gutless to help those people.  

And escalating premiums are ONE problem of Healthcare... not the ONLY problem of healthcare.    There are several problems equally as important, many of which are solved with the Senate bill.  

And I support the Mandate... EVERYONE should have to buy healthcare.    This is one case where people should be protected from their own stupidity.

[ Parent ]
The mandate would be fine (4.00 / 2)
If we actually got anything for it.
[ Parent ]
Pls don't waste time "discussing" with this agent provocateur! (0.00 / 0)
He never answers. Obviously isn't interested in discussion. And at the same time always post crap critical of progressives. I suspect he's a right wing mole.
[ Parent ]
Did you support the 2003 prescription drug benefit law? (0.00 / 0)

[ Parent ]
no. (0.00 / 0)

[ Parent ]
you say costs? (2.67 / 3)
other countries cover more, live more and spend less

http://en.wikipedia.org/wiki/H...

[ Parent ]
The reason it failed is that we let people profit from others illness (4.00 / 3)
Greed will prevent this country from ever moving to an illness prevention system as long as all of the above profit from us being sick.  
[ Parent ]
Posting provocations and then not discussing them is trollish. (0.00 / 0)
And you obviously aren't a progressive. Sry, but as long as you don't answer questions here, I'll treat you as a rethuglican troll and TR you. Enough is enough.  
[ Parent ]
Yikes. (0.00 / 0)
I just had to check the url, to see if I had somehow got transported to Kosnikia.
[ Parent ]
You should have checked that guys record of comments instead (0.00 / 0)
Here:
http://www.openleft.com/user/Z...

Nothing but disdainb for progressive policies and values. Not a single positive contribution. Not even the will to engage in discussions. And no honesty about his political stance. And the crap he posted in QuickHits isn't even in this list!

As far as I can see that's a right wing mole, only out to disrupt our discussions! A troll. And while OL is more tolerant than DKos, imho there should be a limit to our hospitality to those who don't really want to discuss progressive issues in good faith. I really would like Chris to check this guy, and decide if he really wants him here.

[ Parent ]
Also, I tried to get an answer from him 14 hours ago. Nothing. (0.00 / 0)
Here's that comment:
http://www.openleft.com/showCo...

And that wasn't the first one! Time and again, for some weeks now, I tried to get an answer from this jerk about what's his point joining a progressive blog. Nada!  I really tried to engage in a good faith discussion with him, and dozens of our folks tried that,too, but he obviously only wants to post his crap to annoy people. Really, enough is enough. THIS IS A TROLL, and I'm gonna treat him as such.

[ Parent ]
nothing will happen in the near future (0.00 / 0)
Further legislative action on anything non-militaristic will only happen under one of two conditions: 1) Senate Dems decide to undermine the filibuster; 2) Republicans gain control of the Senate. Option 2 doesn't get you health care reform.

One train of logic from the above says the House should pass the Senate health care bill and get it over with. A bill is better than no bill.

The other train of logic is that a fight over the filibuster is inevitable, given the number of problems that require Federal legislative solutions. Why delay it any more? The House may have maximum leverage to get the Senate to finally deal with the filibuster right now, by holding hostage the only remaining legislative action that can be taken without filibuster reform.

If there is any bloc in the House that is actually pursuing this strategy, they need to get their PR in gear: this is a fight they can win in the sphere of public opinion, but only if they start making their case strongly.

Pass the damn bill (4.00 / 2)
It is a multi-step process:

1) The House passes the Senate bill as is, no need to go back to the Senate.

2) Make improvements via reconciliation and other legislative avenues.

3) Make improvements via reconciliation and other legislative avenues.

4) Make improvements via reconciliation and other legislative avenues.
...

This ain't rocket science.

Yeah, well the House liberals are having none of it... (0.00 / 0)
Incredible cowardice and arrogance on everyone's part...

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!
[ Parent ]
Did you support the 2003 prescription drug benefit law? (0.00 / 0)

[ Parent ]
If I was in the house, I would have voted for it... (4.00 / 1)
Certainly, I would have preferred another option, but if it was between that and nothing for another 20 years, I would have voted for that.

Sick people cannot afford to wait for perfection.

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!

[ Parent ]
Okay. Would being in the Senate have made any difference? (0.00 / 0)
I was referring to the final, post-conference committee bill.
[ Parent ]
no. (0.00 / 0)

[ Parent ]
Do you support the Senate health care bill? (0.00 / 0)

[ Parent ]
no. (4.00 / 1)

[ Parent ]
Okay, thanks for being consistent (0.00 / 0)

[ Parent ]
It's a pretty simple value judgment. (0.00 / 0)
Do I support ANY subsidies/rewards for the worst actors in US "healthcare"?

NO.

Further -- although I oppose the death penalty where human beings are concerned, I support the death penalty for ALL for-profiteer "healthcare" corporations, as soon as possible, by whatever means are necessary.

Health care is a right, not a commodity for those who can afford it.

[ Parent ]
No one trusts the Senate to make the improvements (0.00 / 0)
Such lack of trust is completely warranted.  
[ Parent ]
Doesn't matter (4.00 / 1)
You do it anyway and then keep on working.  I'm talking about trading one for the other, I'm talking about plugging away and not stopping.  No trust required, just effort.
[ Parent ]
What? (0.00 / 0)
That's like asking you to shoot yourself in the foot, but don't worry, the hospital's only five miles away, just keep walking and don't stop...
[ Parent ]
No (0.00 / 0)
It is like swimming without a life preserver (now) over to a log to hold on to (Senate bill) in hopes a ship comes by.  Even if that ship never comes by, you are far better off holding on to that floating log than just dog paddling.

The status quo of health care in this country is abysmal.  The end result of the Senate bill is a bad system that only sort of works, but is orders of magnitude better than what we have today, that doesn't work at all.

So yes, I say vote for the floating log.  It ain't no boat, but its better than drowning.

[ Parent ]
After we grab on to this log (0.00 / 0)
The people on board the ship are gonna go, "eh, they're alright now; they doesn't need us."

Meanwhile, the log is full of holes chewed out by termites (Ben Nelson and Joe Lieberman) and we'll sink in a few hours anyway.  Unfortunately, we had to pay $900 billion for that useless log.

[ Parent ]
Better analogy... (0.00 / 0)
That's like asking you to shoot yourself in the foot...

When the choice is the head or the foot, better to go for the foot.  Those against this bill are suggesting suicide, pure and simple.

[ Parent ]
This bill isn't a bullet, actually (0.00 / 0)
It's like rat poison being disguised as medicine.  We drink it and say, "okay we've done something; we'll be okay now" as the poison slowly and stealthily kills us from inside.
[ Parent ]
I do agree that we need to map out a plan for how to get Medicare for All (4.00 / 1)
Step 1, of course, is to elect Marcy Winograd and other progressives who support Medicare for All.  Passing it would be much easier if we have a supportive team already in place.  Imagine how easy passing the public option would've been this time around had we already had a bunch of Senators who were openly for it, instead of having to ask and demand and claw and bitch for every vote.

The other important ingredient, however, is to really push Medicare for All into the marketplace of ideas.  Outside of Anthony Weiner, no one really talks about it on TV.  I'm sure most people don't even know what "single payer" means. (Hell, a lot of people don't even seem to understand that Medicare is a government program.) We really need to get out there and just get people acquainted with the idea, so when the future fight comes people will already know what it is and have been able to form an opinion about it.

Of course, part of that is also to get people to know that liberals are largely dissatisfied with the current health care bills.  Otherwise, the "fix it later" strategy will be derailed by "I thought we just passed something big, why do we need to do any more?"

gets less progressive each time (4.00 / 1)
Each attempt at health care reform has been less progressive than the last. If this attempt fails the next attempt will be significantly less progressive than the Senate bill.
Well the country as a whole has gotten less progressive (0.00 / 0)
and as a consequence the government has too.

Also, I think this current bill would be more progressive than Clinton's if it had a public option.  The public option is the key to me because it's the difference between government providing health insurance to its people or a huge corporate giveaway to the same insurance industry that screwed us in the first place.

[ Parent ]
What are you talking about? (0.00 / 0)
Well the country as a whole has gotten less progressive

I don't see any evidence of this.  Any specifics?

Who are the best keepers of the people's liberties? The people themselves. The sacred trust can be no where so safe as in the hands most interested in preserving it.
James Madison

[ Parent ]
I meant relative to the 1960s (0.00 / 0)
The last time we passed major changes to the health care system.

I think the country has moved left from where it was in the 80s and 90s, certainly, but not quite back to where it was before then.  We still have not eliminated the ideological taint of conservatism.

[ Parent ]
This plan doesn't take effect for years. (0.00 / 0)
Medicare was implemented in one year.  We can wait another two years and still pass this lousy bill with no delay in implementation if you want to.  But if you want to really force this issue into hibernation for another 17.5 years, pass this illusion of a fix.

Moreover, "back to the drawing board" also keeps this issue alive for the November elections.  It is often said, with little explanation, that you can't get things passed in an election year.  But you can try to make some politicians commit.  Keep it alive for 2010.  It helps both the issue and the election.

It would keep the issue alive (0.00 / 0)
as a negative one for the Democrats:

The Democrats wanted to pass a horrible liberal healthcare bill that would've destroyed America, but they were so weak and cowardly and feckless they couldn't even get that done. Thank God for the GOP!

Awesome plan.

[ Parent ]
The future of health care reform (after this attempt) | 63 comments
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