Implications of a Kucinich "yes" vote on health reform

by: Chris Bowers

Tue Mar 16, 2010 at 22:51


Representative Dennis Kucinich is holding a press conference tomorrow at 10 a.m., eastern, to announce his vote on the health reform package.  On Countdown tonight, Howard Fineman reported that Kucinich is now a “yes.”

There is no guarantee this is true.  But, if true, there are many implications:

  • Only eight away from passage. Given the three other Democrats who came out in support of the bill today (Maffei, Doyle and Kirkpatrick), the “yes” and “lean yes” totals on the package would rise to 208, only eight away from passage.

  • Did he win a concession?  Kucinich had made several, specific demands in return for his vote.  The most prominent of those was an ERISA waiver.  Jane Hamsher:

    Kucinich told Obama that he wants a full ERISA waver and a public option in exchange for his vote.  And if he actually gets an ERISA waver, it will be the biggest victory of the entire health care debate.   As Jon Walker says, “ERISA is the 900 pound Gorilla that has fucked up America’s health care system something good.”

    I definitely don’t agree that it would be the biggest victory in the debate.  After all, this is just the possibility of state single payer, not actual single-payer (and no, Pennsylvania is not close to enacting single-payer).  By contrast, Bernie Sanders has scored public primary care for 22 million people.  But, it would still would become another way that progressives strengthened the bill.

  • Does Kucinich bring anyone with him? While Kucinich is the last House Progressive holding out on the bill, and thus can’t bring anymore votes with him, it is worth asking whether his support brings along any progressive activists.  If Kucinich won at least one of his demands, such as the ERISA waiver, will any of the not insignificant amount of progressive activists supporting Kucinich come along with him?  Or, will those activists reject Kucinich, too, because he didn’t win all of his demands? (or many his demands were never enough in the first place for some).
This is certainly the most interesting vote update of the day.  I wasn’t going to watch before, but now Kucinich’s press conference has become a must-see.
Chris Bowers :: Implications of a Kucinich “yes” vote on health reform

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Implications of a Kucinich "yes" vote on health reform | 84 comments
"a must see" (4.00 / 1)
good news or bad, tomorrow certainly is.

We need more organizing. The old fashioned kind of commitments and lists and trees. The delivery of votes is where power comes from. Mere denial and supression is paltry. We need to elect the kind of people we threaten our Reps and Senators with.

—

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

 
It would be the biggest because it leads to more than you already have (4.00 / 4)
strategically right now for the future.

The reality is that this bill does not create a way forward for progressives to fight another day.

A concession on ERISA would.

We already have California, where we are one governor’s race away from single payer. That represents, if my math is correct, 1/10 of the U.S. population under single payer.

In two moves, the inclusion of the ERISA exemption and a single governor’s race where we are right now probably leaning towards a Democratic pick up, we move 30 plus million people into a public health care rather than for profit system.

It would be transformative. Until recently , I had not done research on this issue, but on looking at it, is definitely unlike now, a concession that would change the game regarding healthcare reform going forward into the future. Nothing else in the bill does this.

Finally, I don’t understand how people can both discuss how we are just at the first step of a long term battle, and thus why this bill should be pass, and yet, seem unable to have a discussion about what is the way forward after this bill passes.

The ERISA carve out is such a discussion.  

 
The waivers on state innovation are good. (4.00 / 1)
And the most likely path to SP is probably through the states.  California seems to be close.

This, however…

The reality is that this bill does not create a way forward for progressives to fight another day.

…simply is not true.

We PTDB! Now, let’s pass Grayson’s Public Option Act!
[ Parent ]  
What strategically will allow for further moves as a direct result of the language (4.00 / 1)
of the bill down the road? What further moves are enabled? Describe them to me, and how such moves will work.
[ Parent ]  
Medicare buy-in…. (4.00 / 3)
…you can pop that right into the exchanges…

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 ]  
Is that a part of the existing bill right now? Yes or no. (4.00 / 1)

[ Parent ]  
I believe the definition of "down the road" (0.00 / 0)
is “in the future”.
[ Parent ]  
that comment had a modifier that you did not include. why is that? (0.00 / 0)
the fact you went around it in fact is interesting.
[ Parent ]  
Amusing. (4.00 / 1)
While I was preparing my “comprehensive” response, you shot right to the point with a quick easy add-on.

Well done sir.

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

[ Parent ]  
He mentioned something that is not a part of this bill (4.00 / 1)
And in your mind this is example of something that answers my extremely specific question?

I can’t decide whether you two actually believing what youa re peddling or are just so insulting that you assume that you can throw this sort of comment out there without any one realizing you expect the same Congress progressives who just screwed us over to not do the same in the future.

Sorry, but you and the rest of DC progressives have used all your hope up.  

[ Parent ]  
Clearly you didn't ask what you meant to ask. (0.00 / 0)
Since both he and I interpreted your questions the same way.  Or are you trying to ask something different now that you don’t like the answer?

We PTDB! Now, let’s pass Grayson’s Public Option Act!
[ Parent ]  
Lord, look, you clearly have no answer or can't read (0.00 / 0)
Here’s what I wrote:

“What strategically will allow for further moves as a direct result of the language (0.00 / 0)
of the bill down the road? What further moves are enabled? Describe them to me, and how such moves will work.”

It specifies language of the bill. There’s no way to be more specific than language of the bill.  

[ Parent ]  
You said this bill has no way forward. (0.00 / 0)
The reality is that this bill does not create a way forward for progressives to fight another day.

You said that.  I took issue with this and then explained how you are wrong.  I have shown how progressives can fight another day even more effectively after HCR has been passed.  What I said was pertinent to your question, you are just unhappy with the answer because it doesn’t support your position.

Until you address what I said in response, I am done with this discussion.  If you want to see what a substantive response looks like, look at liberalmaverick’s below.

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

[ Parent ]  
A new playing field. (4.00 / 3)
Policywise: Grayson’s Public Option Act would work loads better in combination with the comprehensive bill than in isolation.

Politically: Success on HCR makes passage of Grayson’s bill or a compromise thereof more likely, not less.

Dividends:  There are all sorts of grants, studies, and incentives for innovation in this bill that will likely pay dividends far beyond what is recognized at the moment.  If you have time, read this article, it helped change my perspective on the Senate Bill.  http://www.newyorker.com/repor…

Interest groups:  We’ve seen the influence that interest groups have throughout the process, and how detrimental they’ve been to reform.  Part of the problem is that to do reform comprehensively, you have to touch so many sectors.  It is impossible to take on Insurance Companies, PHRMA, Doctors, Lawyers, etc. all at once.  The main reason Medicare+5 PO was a no-go was because rural hospitals complained it would hurt their bottom line.  Once a comprehensive bill is passed, you can take on each of these constituencies on their own, and pass reforms that they may not like, but which help the health care system as a whole.

None of this is possible though, without passing the comprehensive HCR bill.  Without that cornerstone, these reforms are much less effective, reformers are left arguing about where to start.

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

[ Parent ]  
Lord, look, you must be joking (4.00 / 2)
If you truly believe this stuff, then I really feel sorry for you.

A realistic way forward in the language of the existing bill,a nd you respond a) with a non sequitur based on your hope over progressives in Congress who just got through screw us over and b) can’t point to the langage in the actual bll.

The rest is a joke not even worth discussing.

[ Parent ]  
Well, it's a waste of time trying to reason with you. (0.00 / 0)
I just tried, but you’ve been running around sniping and insulting everyone for some time now.

You asked me this.

What further moves are enabled?

Explain to me how what I wrote doesn’t address this question at all.

You are full of it.  You just don’t like my answer, so you attack and insult, without addressing anything I’ve said.  Same as you do with everyone else you disagree with.

As far as specific things in the bill, I addressed that in the “Dividends” paragraph.  I’m not going to waste my time pulling specific quotes out if you’re just going to call me names and try to dismiss everything I say.  Go read the bill yourself.

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

[ Parent ]  
Reasoning? Where do you reason here? You simply state you hope (4.00 / 1)
something may happen without regard to the language of the bill itself or how one can use that language strategically in the future.

Again, I was precise for a reasons. I get the hope game you and others play. You and other person ignored it to argue hope.

Your arguments are not based on any actual policy changes in the bill itself. It is based on the liberal psychology of hoping they will do x, y or z.  Whereas a change ERISA exception is not a hoped for change. It would be an actual change in statutory language. Now, the question is did this happen? who knows, but I can tell the difference between hope and a concrete change in language.

Whereas, your argument is based on hoping people who have already failed to do so once will somehow change stripes in the future. With what do you justify this belief? You can’t. You simply tell me to believe. The problem is the evidence is contra to your belief. 60 progressives signed a letter they later ignored. That tells me their word means nothing.  

[ Parent ]  
No. (4.00 / 1)
You said this originally:
The reality is that this bill does not create a way forward for progressives to fight another day.

I have shown a way forward based on passage of the bill, because of the environment that gives us (where government action in HC becomes the precedent).

I gave my reasoning about how we can more easily divide and conquer the interest groups in that environment.

I even gave an example of how specifically we can move forward.  Grayson’s bill is more than just hope unless you plan to just sit back and let others do all the hard work.

Besides, you have a lot of nerve trying to criticize me on “hope” when your biggest excitement about this bill is potentially amending ERISA, which does nothing except provide for the possibility of state based single payer.  You still have to “hope” that a state actually comes through and does it.

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

[ Parent ]  
… (2.00 / 2)
You’re arguing with someone who has proven himself ignorant of this Bill for months now.   Don’t beat your head against a brick wall.   He won’t let facts or reason fuck up his argument.
[ Parent ]  
Like the other peson you left out the rest of what I said (4.00 / 1)
this is so dishonest at this point it is a waste of time. Either read my comments in their entirety or stop pretending to answer them. YOu can say what you want by talking to yourself and others who want to respond to what you want to talk about.
[ Parent ]  
I found what you said to be untrue. (0.00 / 0)
And showed why I thought that.  You may not like the answer, but that isn’t my fault.

Agree with you that this is a waste of time at this point though.

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

[ Parent ]  
Playing field tilted against us, I'm afraid (4.00 / 2)
Policywise: Grayson’s Public Option Act would work loads better in combination with the comprehensive bill than in isolation.

This I agree with, though I think people here tend to overstate the necessity of the individual mandate.  I think it would be very possible for a government insurance program to weed out those with legitimate complaints from those who irresponsibly wait until the last minute to get health insurance.  If Medicare can figure out a way to do this I think it would be enormously preferable to a mandate.

Politically: Success on HCR makes passage of Grayson’s bill or a compromise thereof more likely, not less.

This I strongly disagree with.  An insurance industry that just got a captive market are gonna fight tooth and nail to make sure that they have that market (i.e. the whole freakin country) all to themselves.  There aren’t enough non-insurance industry owned members of Congress to overcome this.

Moreover, members of Congress (especially Senators) will be “too tired” or otherwise distracted to touch another health care-related issue this year, before we all get our asses kicked in November.  While it’s difficult to predict Congressional majorities in the future, with a potentially bad year coming up in 2014 it’s likely we won’t have enough liberals in the Senate to pass a Medicare Buy-in until 2017 at the earliest.

And then we have to contend with whether or not the House or the White House are occupied with sufficiently liberal people.  Remember, the last President who was (arguably) a real liberal left office in 1969.  The last Democratic Presidential nominee who was (a little less arguably) a real liberal ran in 1984.

Dividends:  There are all sorts of grants, studies, and incentives for innovation in this bill that will likely pay dividends far beyond what is recognized at the moment.

Okay, sure, though I don’t see how this helps us pass the Medicare Buy-in.

Interest groups:  We’ve seen the influence that interest groups have throughout the process, and how detrimental they’ve been to reform.  Part of the problem is that to do reform comprehensively, you have to touch so many sectors.  It is impossible to take on Insurance Companies, PHRMA, Doctors, Lawyers, etc. all at once.  The main reason Medicare+5 PO was a no-go was because rural hospitals complained it would hurt their bottom line.  Once a comprehensive bill is passed, you can take on each of these constituencies on their own, and pass reforms that they may not like, but which help the health care system as a whole.

Again, we’ll have just given the insurance industry a huge captive market, and then after we do that, we’re gonna try taking some of that away?  Talk about closing the barn door after the horse has already galloped far far away, laughing its head off all the way to the bank.

I’m sure parents will know what I mean.  There’s a reason why parents demand their children to eat their vegetables before they get the ice cream.  Can you imagine how things will work out if you tell your kids to eat their veggies after they’ve had their fill of ice cream?  They won’t be anywhere near the veggies, that’s for sure.

And I don’t see how this bill makes rural Blue Dogs any more likely to vote for a Medicare Buy-in, unless the bill changes reimbursement rates for Medicare in rural areas. (Does it?) Even so, the combination of conservative instincts and special interest money (which will be flowing like water around these people) may be too difficult to overcome.

None of this is possible though, without passing the comprehensive HCR bill.  Without that cornerstone, these reforms are much less effective, reformers are left arguing about where to start.

Here’s the plan:

1. Elect members of Congress and a President who support Medicare for All.
2. Pass Medicare for All.

[ Parent ]  
Thank you for the substantive response. (0.00 / 0)
And I don’t see how this bill makes rural Blue Dogs any more likely to vote for a Medicare Buy-in, unless the bill changes reimbursement rates for Medicare in rural areas. (Does it?)

I don’t suppose it does make them more likely to support Medicare Buy-in, but we also have the advantage in that we can be more flexible in our negotiations with them.  You can cut a deal with them on tweaking Medicare rates if you need to.  You can use the popularity of the idea as a stick if necessary.

This works better in an environment where HCR has been passed because there are less places where blue dogs can hide.  Right now, if you were to try to make a deal like this, these same blue dogs will then complain that the bill costs too much, or that they don’t like all the backroom deals, you get the idea.  A four page bill is a lot harder to lie about.

1. Elect members of Congress and a President who support Medicare for All.
2. Pass Medicare for All.

If that’s your plan, we aren’t going to get there until at least 2017 anyway, and that is being generous.  We are going to lose seats this year, more if HCR goes down.  Members of Congress may be weary of HC once this passes (i.e. McCaskill), but if it doesn’t pass, they will be too terrified to tackle it again.  You will start to hear even more of the old canard “the American people don’t want us to focus on this, they want us working on jobs.”

Your preferred path takes for granted that if reform fails, people will turn to medicare for all.  I think history shows that if reform fails it will be even less ambitious next time…a decade or more down the road.

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

[ Parent ]  
if the need is real, (4.00 / 2)
then it’s going to get done, one way or another. To say that merely because the need was frustrated this once, it will go away entirely, is like saying that abstinence can rid one of sexual desire.

Obama’s making a clever conflation–he’s saying this is the last chance for health care reform, when it’s only his last chance. I’m not buying that trick.

Passing a bill that grants so much more power and wealth to the insurance companies, in the hopes that it somehow, in the future, it can be fixed, is not a valid argument, because it means that the foes of reform will be that much better armed to stop any further fixes from happening.

“Hope” was a great campaign slogan but it’s a poor governing principle.

[ Parent ]  
If it's his last chance… (4.00 / 1)
Then it’s the last chance for at least 8 years, by simple presidential math.  Realistically more like 12 or 16.

The special interests will only be more powerful then as well, with no regulations checking them at all, and no precedent set for regulation of the HC sector on the necessary scale to rein them in.

And if the need is real and is going to get done, and this bill and its amendments somehow doesn’t get it done, why would passing this bill stop the reform you speak of from happening?

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

[ Parent ]  
I told you the reason, (4.00 / 5)
as did others. The bill gives the insurance companies a captive market, which means they will have many hundreds of billions more to block reform, to hire more lawyers to wait out suits for wrongful denial of care, etc.

Pass this bill, and the politicians will respond for calls to “fix it” by telling us to shut up and be grateful for what we got. Popular opinion will be confused, with some people wanting more reform and others not seeing the point, because, after all, a health care bill was passed. Then once enough people realize this bill was a piece of crap, and try to come back to repair it, they will face a far wealthier and more powerful insurance lobby, one able to blow twenty million a day lobbying Congress, rather than the paltry one million they are blowing now.

This is a choice between awful and godawful. It’s too late to have anything resembling a good outcome. If the WH had fought for the public option, we might have gotten it. But it’s too late for that now.

There is nothing to be done but to acknowledge this, and move on, instead of desperately scratching around for some crumb of hope.  

[ Parent ]  
n/t (4.00 / 2)
This works better in an environment where HCR has been passed because there are less places where blue dogs can hide.  Right now, if you were to try to make a deal like this, these same blue dogs will then complain that the bill costs too much, or that they don’t like all the backroom deals, you get the idea.  A four page bill is a lot harder to lie about.

I don’t think so.  Once this current comprehensive bill passes, Blue Dogs will just say, “I’m tired; leave me alone.”  They’re certainly not gonna get on board with something that expands Medicare, a program most of them don’t particularly like.  Lies, btw, don’t matter – Blue Dogs can count on conservatives to make them up for them, and in any case they can just say that Medicare sucks; doesn’t pay enough; etc.

I think if we’re able to generate a huge amount of public pressure it might force the Blue Dogs to give in, but it’ll be very difficult, and even more so if the HCR bill passes because it’ll lead many to become complacent.  Also, people will be busy working for campaigns to defend the “heroic incumbent Democrats who passed this grand progressive health care bill!!”

Right now, though, while the bill hasn’t been passed yet, we have all the leverage on the Blue Dogs because of the political fallout that will happen if the bill doesn’t pass.  While I disagree with the extent of the fallout that many of the pass-the-billers state (I think everyone tends to exaggerate the political differences between the bill passing and failing), I do think that whatever fallout does happen, it’ll hit Blue Dogs the hardest.  We have this political leverage over them and we should be using it for a public option!  That leverage disappears once we pass the bill.

If that’s your plan, we aren’t going to get there until at least 2017 anyway, and that is being generous.  We are going to lose seats this year, more if HCR goes down.  Members of Congress may be weary of HC once this passes (i.e. McCaskill), but if it doesn’t pass, they will be too terrified to tackle it again.  You will start to hear even more of the old canard “the American people don’t want us to focus on this, they want us working on jobs.”

Failure alone doesn’t instill terror.  The terror comes from public backlash, leading to defeat in reelection.  That terror can be avoided if Democrats explain what’s wrong with the bill and why we have to start over.  But, no one’s gonna do that, cuz no one dares challenge the President and think/speak for themselves.

Btw, I was being facetious with the simplicity of my “plan”; it was to illustrate that the right thing to do is also the simplest.  Obviously things are gonna be a little more complicated than that.

Your preferred path takes for granted that if reform fails, people will turn to medicare for all.  I think history shows that if reform fails it will be even less ambitious next time…a decade or more down the road.

Well personally I think this HCR bill is more ambitious than the Clinton effort, and would be worth supporting if only it had a public option.  I think if the health care crisis gets bad enough people will turn to the idea of Medicare for All.  Also, Medicare for All needs more time to grow on the American people.  Right now there isn’t a tenth of the public advocacy for it that’s needed to get it passed sometime before we all die.

If we pass this bill, people will tend to think that everything’s solved! and they’ll tune out that crazy guy on the street corner or on TV talking about what sounds like socialism.

I’m not sure exactly how to get to Medicare for All, but I do know it’ll involve a lot of 1.) Public advocacy for it, to get people used to and receptive to the idea 2.) Electing supporters to Congress.  Yes, it’ll take time, but at least when it does come we know we’re getting something of value.  With this bill, we’re passing an insurance giveaway, and then sometime in the indeterminate future, we might get Medicare Buy-in.  In the meantime, insurance companies are accruing more and more power, while ripping off the American people to greater and greater degrees.

Of course, I don’t think these strategies are mutually exclusive.  We probably will have to ask for Medicare for All and then have to compromise to Medicare Buy-in.  Which makes me wonder what we’ll have to ask for to get actual Medicare for All.

Finally, I think one actual viable way to get to Medicare for All is to pass the current HCR bill, and then have it fail, e.g. by having the individual mandate successfully challenged as unconstitutional or something.  Then maybe lawmakers will give up on these market-based jury-rigged systems and just give in to “socialism”.  Unfortunately, this pathway involves a lot of risk, in more ways than one.

[ Parent ]  
The status quo is unsustainable (4.00 / 1)
and that provides incentive for reform of the health care system. Even conservative reupublicans and corporate leaders understand this.

Where will that need go if the insurance “reform” package now before the congress is not passed?

Will tweaking the system by passing a half-measure bill – that most supporters agree has to be “fixed” even before it has been passed – increase, or decrease the pressure to revisit reform of the health care industry?

Passing a bill that needs fixing right from the get-go seems a very high risk strategy with very little evidence that it the political will to revisit the issue will be present in the next few years.



“It sounds wrong…
     …but its right.”

[ Parent ]  
Something I wanted to add. (0.00 / 0)
Policywise: Grayson’s Public Option Act would work loads better in combination with the comprehensive bill than in isolation.

This I agree with, though I think people here tend to overstate the necessity of the individual mandate.  I think it would be very possible for a government insurance program to weed out those with legitimate complaints from those who irresponsibly wait until the last minute to get health insurance.  If Medicare can figure out a way to do this I think it would be enormously preferable to a mandate.

The mandate is not the only reason why Grayson’s bill works better with the Comprehensive reform bill.  By all calculations, buying into medicare is very expensive.  Could be unaffordable for lots of people.  The subsidies would enable more people to benefit directly from Medicare, while further broadening the pool and improving Medicare’s finances.

Plus then you have a situation where taxes are being collected to subsidize people enrolling in Medicare…hmm, that idea seems awfully familiar…  😉

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

[ Parent ]  
Sure, but we can have subsidies for Medicare Buy-in without a mandate (4.00 / 2)

[ Parent ]  
Then you have the complaints about cost again. (0.00 / 0)
Medicare Buy-in w/ tweaks in reimbursement rates as a sweetener might work for Blue dogs.  You throw in hundreds of billions in subsidies again, and you have a whole new ball of wax.

It gets complicated very quickly.

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

[ Parent ]  
We have complaints about costs right now (0.00 / 0)
so there’s no way to get around that, unless you have a magical plan where you can get everyone health insurance without spending any money.

In any case, none of that requires a mandate.

[ Parent ]  
Costs. (0.00 / 0)
You’re right, we do have those complaints now.  But once the main bill is off the table, you can move on and debate the PO without having to debate expensive subsidies at the same time.  It gives blue dogs less opportunity to oppose.

We PTDB! Now, let’s pass Grayson’s Public Option Act!
[ Parent ]  
As if they needed this "opportunity to oppose" (0.00 / 0)
By god, if all we had to do to pass something was to knock down the opposing side’s arguments, like in a debate tournament, we would’ve had Medicare for All 30 years ago.

Passing this bill will not make passing a Medicare Buy-in easier – if anything it’ll make it harder, as an emboldened and strengthened insurance industry will have had a taste of the ice cream and unleash their wholly owned Members of Congress to defeat any effort to make them eat their veggies.

[ Parent ]  
We have complaints about costs right now (0.00 / 0)
so there’s no way to get around that, unless you have a magical plan where you can get everyone health insurance without spending any money.

In any case, none of that requires a mandate.

[ Parent ]  
I think you have the adverse selection problem there (0.00 / 0)
If people can enroll in Medicare only after they’ve been diagnosed with something demanding expensive treatment, then they probably will wait.  Which means Medicare is on the hook for tons of expensive pay-outs, but won’t have increased revenues.
[ Parent ]  
I'm not sure which idea you're responding to (0.00 / 0)
the straight-up Medicare buy-in, or my proposal that Medicare covers anyone who has been denied coverage due to a preexisting condition.

In either case, I think the bureaucrats in Medicare can assess whether a given consumer is someone who really needs health care and has been unfairly denied, or just someone who wanted a free ride.  They can make these distinctions and act accordingly without the need to mandate people to buy private insurance.

[ Parent ]  
I meant the straight-up buy-in (0.00 / 0)
If Medicare is available to everyone, then I don’t think there is any mandate to buy private insurance — it’s a mandate to buy something, and one option would be private insurance, but another option would be Medicare.  Which is similar to just using general tax revenue to fund public insurance, as long as the price you pay for coverage (private or Medicare) is means-tested, like a progressive tax structure.
[ Parent ]  
Ah, I see (0.00 / 0)
Well the question was, can a Medicare Buy-in be created without a mandate to carry insurance?  I think yes, and this might mean that Medicare would have to turn away people who’ve waited too long to get insurance.  But Medicare can accept those who’ve legitimately attempted to get insurance in the past, and were denied because of a preexisting condition.
[ Parent ]  
The structure makes Grayson's bill possible (4.00 / 1)
Right? If that isn’t a path forward I don’t know what is.
[ Parent ]  
I think those are separate issues, but I am not 100 percent sure (0.00 / 0)
Like I said, I have only just recently due to reading someone else’s diary come to realize the importance of this particular provision. As someone mentions below, if you look abroad to Canada it opens up a strategy for true incremental transformation of the country because there are bills moving forward in CA, PA (according to Chris less likely than what we are being told but nevertheless an opportunity for activist to fight out for more after the national bill passes), and believe it or not in I believe a southern state or two amongst others. There is not imcrementalism involved in the rest of the bill other than reinforcing what the bill will create as the status quo.
[ Parent ]  
Also note that (4.00 / 1)
Social Security began in a very similar way to this–FDR consciously modeled the federal program on policy that existed in Wisconsin already.  The biggest boost single payer at the federal level could have is being enacted in a particular state and than having it work there.  
[ Parent ]  
Especially considering the failure of the national progressive leaders (4.00 / 1)
My view is that trusting them given their failures is a big mistake. Certainly no one here can give much beyond platitudes about how we just have to hope for the best in the future. Here , again, we have seen legislatures at the state level willing to go further than the national leadership is willing to do. This alone is more encouraging to me than a thousand empty promises, and the value of the impact is that it works its way up as we have domestic examples to prove the point of more change in the future.
[ Parent ]  
Nope. (4.00 / 2)
Grayson’s bill (HR 4789; warning: PDF) amends Title XVIII of the Social Security Act.  No need for the current HCR bill to do that.

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 ]  
California (4.00 / 1)
As I mentioned in the Quick Hit, I don’t know if CA is in the bag.  Jerry Brown is a crappy candidate who is lukewarm at best to the idea of single payer; he might be old, crazy and idiosyncratic enough to veto it, especially if it raises taxes, cuz he hates taxes…

Hopefully I’m wrong and he’ll want to avoid picking that kind of fight.  But he’s at the stage of his life where he isn’t thinking about higher office anymore, and maybe not even reelection.  In any case, I don’t know if a veto on single payer would be enough to kill his chances for reelection.

[ Parent ]  
Yes, my assumption is that brown would not veto it. (0.00 / 0)
But it is also based on the fact that realistically, this is a better option than waiting for national progressives to not enable the conservative status quo. When in doubt and even when not, they do as FlaDem describes. I no longer trust a word they say.
[ Parent ]  
… (0.00 / 0)
National progressives would need to find a majority in the House and (even with reform) a majority in the Senate… that doesn’t exist for Single payer right now.    Too many rich old guys against it with misrepresentations of Britain and Canada… plus the Insurance industry will spend 100 of millions to defeat it.    State by State is the ONLY possible hope and that will be a big challenge, especially with the BS SCOTUS ruling.    Grayson’s bill is the next step, followed by trying to get at least one state to pass Single payer if the opt-out is included in this bill.   It will probably be decades until the prospect of SP is a reality… it certainly sucks that things are that way… but SP will need baby steps.
[ Parent ]  
I am uninterested in reading any more excuses for the failed character of (4.00 / 1)
national progressives.
[ Parent ]  
Votes for single payer (4.00 / 2)

Ian Welsh, who blogged on Open Left and whom I respect, commented on his own blog back in September:

But here’s a truth for you. According to at least one person I know who works in the house, there are enough votes in the House of Reps to pass single payer straight up. My personal guess is that with a lot of arm bending, such a bill might get from 48 to 50 votes in the Senate. (Maybe 51 is Mass gets a new liberal Senator soon enough, and Byrd doesn’t die.)

He then added

Senate numbers are my own guess and I’d be hard pressed to justify it, though I think it’s true.

and further clarified

If they [the House leadership] got behind it, however, they could pass it. To pass it in the Senate would require both the leadership and Obama whipping it. That’s not going to happen.

In part the House leadership was not willing to buck the White House.

So one person (whom I think is reasonably informed) thinks that it’s at least arguable that single payer could gotten at least close to the votes needed to pass. That’s just one person’s opinion, of course, but, as I said, I respect that person’s opinion. (And, clearly, had single-payer advocates not been so completely shut out of the process, as Ian’s scenario implicitly assumes, the entire dynamic might have been different.)


[ Parent ]  
who's to say the state legislature won't suddenly reverse themselves (4.00 / 1)
under a Democratic governor?

True, the legislature passed single-payer already, but they surely knew Arnold would veto it. Passing it allowed them to get the credit and paint Arnold as the villain without risking their own asses by defying the insurance companies. It’s not clear that they actually want to have single-payer.

And surely, once there is a real chance of single-payer in California, the insurance companies will pour millions into defeating it, both by lobbying legislators directly or by spearheading ballot initiatives.

Just as the campaign on Prop 8 was funded by the Mormon Church, working through local organizations, it is easy to imagine Wellpoint working through local anti-tax organizations.

The Howard Jarvis Association would love to have this issue to demagogue on. Bragging on how they’ve defended Prop 13 for 30 years is getting a little old; a campaign to block single-payer would bring money and a lot of young, politically active wingnuts into the fold. It would revive them.

Deficit fever is running high. It would not be hard for the anti-single-payer forces to argue that single-payer is an expensive new service we just can’t afford in these tight times, that all that money will go to treating immigrants and minorities, all the usual right-wing demagoguery.

I’m not saying that single-payer can’t get implemented in CA. But it will be a shitstorm of epic proportions to do it.

[ Parent ]  
Oh god… (0.00 / 0)
You reminded me that this is the part of politics I hate most… the “I’m all for it until it can actually pass, at which point I’m against it” part.
[ Parent ]  
If you say so. My view is that you are speculating on fear (0.00 / 0)
whereas when it comes to certainties that we do know- we do know for certain that the natioanl progressives essentially lied in the letter on the PO. You can only speculate about the individual state legislatures. One is a certain fact. Another is speculation. In terms of hierarchy of evidence- facts trump speculation. That’s how I draw my conclusions.  
[ Parent ]  
ERISA waiver would be the most important progressive victory. (4.00 / 2)
We have Canada as the example of what will happen. Your math on CHCs is questionable. There isn’t a 1:1 relationship between more funding and more patients. The money is only for five years so a lot of it will go to building improvements, and other durable equipment. I’m not knocking it; it’s just not a game changer the way ERISA would be.
 
This means there is not a single vote from the (4.00 / 4)
left in either House against this Bill.

About 4 months ago I resolved to stop commenting in threads at DKOS on HCR because I had concluded that much of the debate over HCR was a charade.  I didn’t always honor my resolve, but I think I was right.  I now believe Bill Nelson was telling the truth last August when he said the Public Option didn’t have a chance.  I am beginning to think almost everyone in the Senate and the House knew that as well.  

The simple truth is that the Progressives in the House and never believed on substance that the Public Option was make or break.  In retrospect the letter 60 Progressives signed last summer demanding the Public Option or else looks incredibly cynical.  They didn’t mean, they had to know they didn’t mean it, and I am damn sure Pelosi knew they didn’t mean it.    


 
Without being too esoteric, the Tibetan language can be said to be 2/3's verbs (4.00 / 2)
the english language conversely can be said to be 2/3’s nouns. Without pointing to any error in the description of your disappointment I dont doubt that what the progressive block’s attempted to bring to fruition is not yet becoming law, but that does reflect on what power they sought to bring forward, nor on their intent. It points merely to the effectiveness of the coalition they sought to lead.

As that coalition is in part electronic pamphleteering cohesions like this one, and therefor like us, it is incumbent upon posters and commentors to do a little more than find external reasons for the outcome we see here.

—

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

[ Parent ]  
What? (0.00 / 0)


“It sounds wrong…
     …but its right.”
[ Parent ]  
I had the same response as "Spitball" at first. (0.00 / 0)
But after rereading it, I understand what you are going for in this post.  It’s kind of a work of art.

We PTDB! Now, let’s pass Grayson’s Public Option Act!
[ Parent ]  
Like a Thomas Kinkaid Painting, or Dogs Playing Poker (4.00 / 1)
It’s a long winded way of saying that we can’t know the CPC’s intentions on this,
which is not true, fladem has put forth the thesis that members of the CPC were engaged in a cynical game of manipulating their constituents and small donors because the Public Option was never going to be in the final bill, and they knew it.

I have no doubt that some of them were that cynical, and some were doing it by supporting the PO right up until they vote for a bill that doesn’t have it — an old liberal standby — some probably did try to do the right thing, even knowing they were surrounded by bought-off hacks and incompetent weaklings.*

But Senate Leadership, and the White House, they all knew it from the word go, and they cynically played with their supporters until they thought the bill they wanted all along was locked in, then they started whipping for votes, and punishing those who wouldn’t toe the line. Funny how Obama didn’t feel the need to twist any arms except progressive ones.

fladem has the right of it, I just think that the CPC isn’t the best place to start looking for payback.

*i.e. Lynn Woolsey.

[ Parent ]  
it is not about pay back so much as being honest about what happened (4.00 / 2)
indeed , even the argument over medicare buy in requires one to ignore the lesson we just got regarding the CPC (regardless of their reasons why).
[ Parent ]  
Assuming I understand what you're saying (which is not completely likely) (4.00 / 1)
The good-intentioned energy of the Progressive Block notwithstanding, most of the Block in both Congress and in the blogosphere (including Open Left) has caved on the public option’s exclusion.  So if Dennis Kucinich did extract this concession, he did so pretty much single-handedly.  And yes, the public option died because of a combination of opposition from conservative Democrats and lack of real, do-or-die support from liberals.
[ Parent ]  
caved. (0.00 / 0)
We dont have their back.
And yes, the public option died because of a combination of opposition from conservative Democrats and lack of real, do-or-die support from liberals.

There are people who want what we want, in both houses. I dont know how many, but more than a handful. There are many who do not, the entire Republican caucus and a large number of the Democratic caucus. A near voting majority who don’t.

And there is a skittish bunch of sellouts who will do anything that ensures re-election or graft or both.

I don’t see cave in this equation. We need to elect more “our side” Democrats, primary out the conservadems and corrupt, and do it by organizing people who aren’t the likeliest to vote, the voters who dont vote, the voters who are kept from voting, and the angry.

And it isnt done merely by being “right” or predicting failure, or being the most cynical. In fact its by doing the opposite.

Is this less esoteric?

—

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

[ Parent ]  
Great comment (0.00 / 0)

[ Parent ]  
If the pattern of capitulation and failure (4.00 / 2)
that we’ve been seeing from the Democrats on absolutely everything for the last two years (and more) doesn’t draw a picture for the so called left, nothing ever will.  

The Democratic Party we all knew is dead.  Clinton killed it.   The party behind the D logo is the new Republican party.   It belongs to corporatists of all stripes that have been freed from the evangelicals, racist south, and the naive and pesky left.   Further proof of the Democratic Party’s demise exists in the fear mongering and propaganda coming out of progressive talk radio and blogs.   DailyKos and Ed Shultz are but two examples.   If you don’t support this bill, you will “kill people”.  How’s that for a fear tactic right out of the old Republican play book.  The latest spin at dailykos on that talking is, if you don’t support the bill you are a white racist who wants to kill people of color.  

Enough is enough, unless you’re a glutton for punishment.  No money, no votes.    

[ Parent ]  
Concession (0.00 / 0)
If Kooch got a concession out of this, I have to give the man some propers. That would be a real-deal power-play, and not at all what I was expecting.

Hope so!

Me | My Work | Future Majority

 
I have to ask (0.00 / 0)
What value do we contribute to the ongoing health care discussion when we speculate on that which is to be said tomorrow. Do we have such little patience that we can’t wait?  In roughly twelve hours he will have spoken.  Perhaps then we can add meaning or understanding.  I don’t think it distinguishes the blog to emulate cable tv.

“Oh. My. God. …. We’re doomed.” — Paul Krugman
http://krugman.blogs.nytimes.c…”>http://krugman.blogs.nytimes.c…”>http://krugman.blogs.nytimes.c…
 
We're not contributing value. (4.00 / 5)
We’re entertaining ourselves. Better than some ways.
[ Parent ]  
Not to be esoteric (4.00 / 1)
But do you mean in Tibetan or English?   🙂

“Oh. My. God. …. We’re doomed.” — Paul Krugman
http://krugman.blogs.nytimes.c…”>http://krugman.blogs.nytimes.c…”>http://krugman.blogs.nytimes.c…
[ Parent ]  
the assumption is that somewhere someone else other than us is reading this (0.00 / 0)

[ Parent ]  
… (0.00 / 0)
Like porn?
[ Parent ]  
This isn't? (4.00 / 1)


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 ]  
Spread (4.00 / 2)
If one state does single payer and it is seen as successful, it will spread fast to a number of others.
 
Doubtful… (4.00 / 2)
1) Many states are deep in deficit right now and also don’t want to raise taxes… so that is an obstacle.  

2) The insurance companies will spend, spend, spend to keep SP from spreading.

That’s not to say it isn’t possible for it to spread, but it will be a long slow painful process… much like Marriage Equality has been.

[ Parent ]  
The ERISA waiver (4.00 / 4)
assuming that is what is going on here, would not just make single payer possible, but also state level public options (which could be crafted in Democratic states without the involvement of people like Ben Nelson) or Hawaii style systems.  States are going to have to enact legislation to create the exchanges, which is going to create a window to add things like a public option. For example, Oregon already has a law in place to develop a proposal for a public option. State officials are already thinking about how to deal with these issues.

In terms of who gets covered in the short term, this won’t have as much of an impact as some of the things in the bill. In terms of the longer term impact, this creates some significant opportunities that the existing bill does not.

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.

 
Ok, Now you've found something worth speculating on (0.00 / 0)
And, conceding that Bruh is right, this bill will be hard to build upon without futher action, the ERISA waiver would be easier than going for a Medicare buy-in.  The action will have to shift to the states in order to get by the Red filibuster and the Obama administration.  Of course it is easy for me to feel this way since I’m three months shy of Medicare and live in Oregon.  I think that for the foreseeable future the Senate bill is about all we get out of the Federal government.  This would make a great place for progressives to invest their time and money.    

“Oh. My. God. …. We’re doomed.” — Paul Krugman
http://krugman.blogs.nytimes.c…”>http://krugman.blogs.nytimes.c…”>http://krugman.blogs.nytimes.c…
[ Parent ]  
Credit Where Due (0.00 / 0)
I’ve never been a big Dennis fan, for a variety of reasons that aren’t relevant to this.  But the man deserves major props for this (assuming the reports are true), especially if he managed to get a concession on state single payer.  This will be the last thing I look up tomorrow before heading off to class.
 
I'm not sure if the single payer waiver would make the bill "worth it" (4.00 / 1)
Here’s what I wrote in a Quick Hit here:

I don’t know where everyone else in the kill-the-bill camp is coming from, but my principal objection is that no one should be forced into private insurance if they don’t want to be.

A state single payer waiver allows states to create single payer public insurance systems, but it’s still up to each state to do it.  There’s no guarantee that this will happen; thus, there is still the real probability that those not fortunate enough to live in or move to a single payer state will be forced into private insurance.  This is essentially an opt-in public option.

Contrast this with an opt-out public option, where everyone by default starts out with the public option, and then people choose to deny their own right to public insurance.  That’s (relatively) okay by me because in this case people are voting to take away their rights.  It’s a lot easier to justify putting in a right by default and then having people choose to deny themselves of it, then by not putting it in and telling everyone they have to claw for it on their own, especially if it’s on a state-by-state basis.


 
And Still you continue to be wrong. (0.00 / 0)
You can’t control the premiums for no pre-existing conditions without mandated insurance as many abusers will only buy insurance when they need it and cancel when they don’t… much like people did with HBO when the Sopranos came on…   Those people will raise the premiums for the rest of us.    THAT IS WHY A MANDATE IS NEEDED!  Yes it sucks, but it is a necessary evil.
[ Parent ]  
Sure… that wasn't even what I was talking about (4.00 / 3)
I was talking about whether or not an ERISA waiver was really “worth it”, if it was really just an enhanced form of state opt-in public option.

I’ve heard the rationale for the mandate a hundred times and I agree it’s a necessary evil, but I think that if you’re gonna have a mandate you also HAVE to have a PO; otherwise insurance companies will just abuse that mandate.  I don’t know why everyone here is so insistent on the most corporate-friendly provision in the bill but when it comes to preventing corporate abuse of consumers, everyone says it’s somehow optional.

[ Parent ]  
the insurance companies were not willing to permit a public option (4.00 / 4)
not even a tiny, balkanized one that was available only to a fraction of the populace and had no competitive advantages over private plans.

It’s unlikely they will permit a way for states to move toward single-payer.

Then one has to weigh the mandates against this possibility of single-payer in some states. With the mandates, the insurance companies will surely get a huge infusion of cash with which to lobby state legislatures to block single-payer. Shouldn’t that neutralize much of the benefit of an ERISA waiver?

 
As someone who has been ragging on Kucinish recently… (4.00 / 2)
….I will happily eat crow if he has wrung this concession out of the bill.
 
Intrade has plummetted with pretty heavy volume… (0.00 / 0)
…down from 70 to 35 in the last 4 hours.

Did I miss something?  If someone is gaming it, it’s got to be a bunch of right wingers ‘cos the volume and number of transactions are high.

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!

 
Bad CBO numbers? Pelosi calling meeting of all female members? (0.00 / 0)
The former is fixable. The latter, set for Wednesday AM, makes me worry we have a Stupak problem, which means 216 may not be achievable.

Self-refuting Christine O’Donnell is proof monkeys are still evolving into humans
[ Parent ]  
I commented on your quick hit… (0.00 / 0)
The AP thinks this is nothing–just one more example of her meeting lawmakers in groups.  History does back it up.  She often meets with the womens’ caucus on issues.

The right wingers are screaming SEXISM and think it’s a nefarious plot of some sort.  Some have speculated like you have, but it may only be wishful thinking on their part.

Stupak claimed Monday night that he’s not been approached in a week… unless something drastic changed today and he didn’t tell anyone about it (unlikely) we’re probably OK.  Let’s not get too paranoid!  😉  I know it’s easy to do!

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 ]  
Oh, and the CBO scores… (0.00 / 0)
…haven’t been made public, nor has any real mention of them taken place this evening to trigger such a selloff…  could be manipulation by the right wingers… don’t count that out!

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 ]  
Implications of a Kucinich "yes" vote on health reform | 84 comments
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