HEALTHCARE THREAD

*dean scream*

i actually am a fan of guy, surprised at his assessment of the proper course of action. agree this is the collapse of hcr tho. for now.

we're #2 but we try harder.

xp

what do u mean by "the collapse" hunter?

depriving insurance companies of the ability to rescind coverage or deny coverage for pre-existing conditions are very valuable insurance regulations. i guess i should wait til i read more on the bill, but i dont see much more.

i dont have a lot of faith these changes will make insurance more affordable for the majority of people who need coverage. insurance is made more affordable when lower risk people who are able to pay for coverage enter the pool. how does this accomplish that? it is designed to allow high risk or expensive people to have access to insurance (which is v. important obv). how does it address healthcare costs? does it still have provisions taxing goldplated plans or subsidies for lower income people?

basically the regulations without the public option will mean an increase in costs. I can't believe anyone is arguing the opposite, this seems baldly obvious.

goole yeah, the contrast has made me realize (realise?) how weak the national parties in the u.s. actually are. just look at the party chairmen. neither of them runs the show. there is no there there! i dunno, i should read up more on the parliamentary whip system, somehow the 'governing party' generally manages to get major policy enacted in the u.k. without months of protracted, public sausage-making.

http://yglesias.thinkprogress.org/archives/2009/12/health-reform-would-dramatically-expand-access-to-health-insurance.php

i'll have to read later, but this is the kind of assessment im seekin

depriving insurance companies of the ability to rescind coverage or deny coverage for pre-existing conditions are very valuable insurance regulations. i guess i should wait til i read more on the bill, but i dont see much more.

to be fair to you and everyone its hard to say exactly whats in the senate health care bill since these negotiations seem to be happening at an hourly rate--that being said (and this is the dems fault, including the white house) the messaging on this bill has been TERRIBLE, meaning that a lot of progressives are standing around calling this a collapse, a ripoff, etc. j0hn was doing it in another thread yesterday. and ill admit it: this is not a great bill. this isnt really in the "very good" bill range. but it is a GOOD bill. like, you know, c+/b-, depending on ones expectations. and this is how progressive policy change on this scale happens--its a foot-in-the-door process. scrapping this bill because it isnt liberal enough means no one will pick healthcare up for another 10 years, and probably more; passing this bill despite its major flaws means that it can be expanded.

as to some of yr specific questions:

i dont have a lot of faith these changes will make insurance more affordable for the majority of people who need coverage. insurance is made more affordable when lower risk people who are able to pay for coverage enter the pool. how does this accomplish that?

i dont know specifically how to address this question but the idea, id guess, is that wide-ranging subsidies + more competitive "insurance marketplaces," or whatever theyre called, will bring more people into the system.

how does it address healthcare costs?

well, it doesnt have a single, wide-ranging, all-encompassing solution for rising healthcare costs... it has dozens and dozens of possible solutions that it proposes to test out in various places. atul gawande writes about it here: http://www.newyorker.com/reporting/2009/12/14/091214fa_fact_gawande?currentPage=all

does it still have provisions taxing goldplated plans or subsidies for lower income people?

the cadillac plan tax is still one of the most contentious elements of the bill--its still in there (last i heard) and may be weakened (i.e. the "cadillac" threshold raised from $8k/$21k to $9.5k/$25k). but i think it has much stronger support from the white house than the public option did, despite opposition from labor, and reid seems committed.

as for subsidies--as you can probably guess from the 538 graph on yglesias's post, its got em. enough? well... that depends on what you consider "affordable" w/r/t healthcare and so forth. but silver argues convincingly that even if theyre not "enough" theyre still vastly better than the "status quo."

i mean i guess the thing that i take away from the whole debate is:

1) the healthcare status quo is terrible.

2) this bill makes the situation (pick one: marginally/somewhat/vastly) better.

3) (and this is the sticking point for all of us i guess) this is the last chance we have for a decade or more to enact reform on this scale and create a structure off which further progressive policy can be built.

i dont have a lot of faith these changes will make insurance more affordable for the majority of people who need coverage. insurance is made more affordable when lower risk people who are able to pay for coverage enter the pool. how does this accomplish that?

i dont know specifically how to address this question but the idea, id guess, is that wide-ranging subsidies + more competitive "insurance marketplaces," or whatever theyre called, will bring more people into the system.

lol i forgot the most important part of this which is the MANDATE that everyone HAS TO HAVE INSURANCE duh

So how is it a good plan to make sure insurance companies have to cover me but not guarantee they have to give me affordable/quality coverage? The lack of price controls or any kind of competition as a hedge against private insurance is pretty indefensible.

not a big truster in the "healthcare marketplace," eh? i mean ideally "the free hand of the market" will guarantee affordable/quality covg, since these marketplaces will give me a variety of choices and force the companies to compete.

but yeah in substance i agree with you. its not really a great plan and im loath to trust the market on something where my life might actually literally hang in the balance.

the difference is i guess that im more willing to defend this bad plan than the even worse plan of letting the status quo continue.

Insurance execs have been giving each other high-fives over HRC for the past few months, and tonight I'm sure they're Top Gunning it. Sure, removing the ability to deny coverage based on previous health history is nice, but at the end of this whole gutwrenching process the fact will remain that we'll still have some of the worst health care systems of the industrialized world, and the underlying problem of rising health care costs will remain relatively unsolved.

1) i think the meme that insurance companies love this bill is a little overwrought, to be honest. theres a lot for them to like in there, to be sure, but theyve been fighting the thing tooth and nail.

2) yeah, the system will still suck. it will suck less.

3) one of the whole reasons for the bills existence is to figure out ways to contain costs--check out the gawande article i posted a few comments ago

1) I think they would've fought it tooth and nail, regardless, because there's no financial benefit to them cheerleading the bill. But if the bill is voted down and HCR fails, then they can continue the status quo which is obviously very advantageous for them. And if the bill is passed but they succeeded in helping to strip down much of what was good about it, such as the creation of a legitimately competitor like the public option, then they also win because they helped to ensure that the HCR that people have been pushing towards for decades is weak, and still lets them rake in massive profits over the misery of others.

2) Probably. Hey, I'm not Howard Deanin' around, if I were a Senator I'd still vote for it. But if my sister was getting punched in the face by a gang of 10 thugs and I could make a deal so that only 3 thugs were punching her in the face instead, and that was my only alternative for the next 10 years, I'd vote for that too. "yay."

3) I read the NYer article when it came in the mail last week, and I get his point. I'm glad they're trying to address the costs through these pilot programs, I hope one works. But it's bittersweet when compared to the promise of a REAL public option alternative, which would've contained costs without the risk of pilot programs.

the legislation Reid will try to get passed before Christmas is not health-care reform any longer, it is insurance reform....

A gleeful Lieberman exclaimed Monday night that: "We're going to regulate the insurance companies and we're going to cut the costs. That's tremendous."

He was wrong on all three accounts.

http://www.thenation.com/blogs/thebeat/506262/a_sucker_punched_harry_reid_throws_in_the_towel_on_real_reform

Lieberman's an easy scapegoat, but like I said on Monday it's Obama's fault for caviling so quickly. Greenwald:

As was painfully predictable all along, the final bill will not have any form of public option, nor will it include the wildly popular expansion of Medicare coverage. Obama supporters are eager to depict the White House as nothing more than a helpless victim in all of this -- the President so deeply wanted a more progressive bill but was sadly thwarted in his noble efforts by those inhumane, corrupt Congressional "centrists." Right. The evidence was overwhelming from the start that the White House was not only indifferent, but opposed, to the provisions most important to progressives. The administration is getting the bill which they, more or less, wanted from the start -- the one that is a huge boon to the health insurance and pharmaceutical industry. And kudos to Russ Feingold for saying so:

Sen. Russ Feingold (D-Wis.), among the most vocal supporters of the public option, said it would be unfair to blame Lieberman for its apparent demise. Feingold said that responsibility ultimately rests with President Barack Obama and he could have insisted on a higher standard for the legislation.

"This bill appears to be legislation that the president wanted in the first place, so I don’t think focusing it on Lieberman really hits the truth," said Feingold. "I think they could have been higher. I certainly think a stronger bill would have been better in every respect."

And the bill's latest provision -- forcing people to buy health insurance from one of the corporate giants -- is a boon to said corporate giants.

"caving" surely? if he'd cavilled a bit more we'd be in better shape

feingold otm. this seems like basically the kind of bill the white house decided was possible. i personally think that has as much to do with what they see as pragmatism as with any actual love for insurance/pharma companies, but that's necessarily a matter of interpretation. i think the calculation always was that the entrenched interests are just too powerful to really substantively challenge. i think they gave away too much on the front end, but no amount of liberal wishful thinking has convinced me that the basic calculation was wrong. we have the system we've built as a country over more than 50 years. that kind of thing has consequences. when you create monsters like the insurance and pharmaceutical industries, you can't just wish them away.

libermans not any more an 'easy scapegoat' that the WH or the president. they all had a hand in the watering-down of the bill. if we need one single thing to blame i think we can all agree that the undemocratic nature of the senate and its procedural rules is the thing to pick on.

No. I have no trouble throwing the president in there too.

yes well thats not "one single thing" anymore then is it

lieberman now trying to save the medicare commission, apparently, for those of you interested in the bill's cost-saving measures:

http://voices.washingtonpost.com/ezra-klein/2009/12/joe_lieberman_jay_rockefeller.html

anyway alfred i think obama is an "easy scapegoat" in the same way lieberman is--its easy to say "heres what he should have done" and "if only."

one of my new years resolutions is to stop getting into these arguments on the board, the ones about the hypothetical actions of the obama administration and white house democrats

one of my new years resolutions is to stop getting into these arguments on the board,

in a mid-term year? gotta commend your guts on this resolution max!

strengthening the medicare commission is a good move. let's see which jackass steps up to kill that.

eh i actually dont mind getting into the relative merits of the obama administration (so far: c+/b-, like this bill--and this thread), what i hate is the "if obama had only done this, we would all have universal health care" or whatever, because, you know, how the hell can you argue against that

for one thing, if obama had "insisted" on something better than the senate bill we started with, it doesn't follow that it would be in better shape now. those with a more pessimistic attitude about the president seem to have much greater faith in the power of his insistence than i do. it's not even clear yet whether this version of the senate bill will make it, for fuck's sake.

i'm completely convinced that this is the best deal possible. i think a better deal would have been killed. i think clinton's plan in 93 was probably better. note that we do not have that plan in place. i think this plan will rein in insurance companies, but yeah, give them a whole new captive customer base (aren't we all), and it will not go hard enough on pharmaceutical companies. apparently they cut a deal early. i wonder if the room was smoke-filled.

but i'm somewhat surprised that those on this thread with ahem greater cynicism about political life aren't, in the end, happier with this outcome. do you think that if this president had taken on pharma, and insurance, and the elderly lobby, and the rump GOP, and the mushy pro-life right edge of his own party, all at once, he would have won? in this country? no, he would have lost. it would have been over for another 30 years.

^^ my man

i don't really see this as obama's failure, but congress's. that's who i'm fucking pissed at.

But if my sister was getting punched in the face by a gang of 10 thugs and I could make a deal so that only 3 thugs were punching her in the face instead, and that was my only alternative for the next 10 years, I'd vote for that too. "yay."

^^^lol love this analogy

and sure it seems like some good regs are coming in but my god, they're of the "insurance companies don't have the right to walk into your home and blow your fucking head off" variety. which of course is important, you know, but.. i guess this is what you get when you start from so far behind. it takes months of momumental agonizing just to go from F to D+.

So is the mandate still in? Cos I haven't paid much close attention to this is weeks but it seems like that is the one thing both parties would definitely agree on (via their HMO lobbyists).

it takes months of momumental agonizing just to go from F to D+.

not just that, but everyone goes home mad feeling like they lost

apparently they cut a deal early. i wonder if the room was smoke-filled.

Of course it was! That way the dealmakers would have to pay for chemo and cancer therapy in fifteen years.

“The Senate version is not worth passing,” former Democratic National Committee Chairman Howard Dean told POLITICO, referring to plans to strip the latest compromise from the bill, a Medicare buy-in. “I think in this particular iteration, this is the end of the road for reform.”

Dean said there are some good elements in the bill, but lawmakers should pull the plug and revisit the issue in Obama’s second term, unless Democrats are willing to shortcut a GOP filibuster. “No one will think this is health care reform. This is not even insurance reform,” he said.

in Obama’s second term

smh

yeah I lol'd at that too.

more goodies:

“There is a growing sense that we’re lifting more than our share,” says California Rep. Xavier Becerra, a member of the Democrats’ leadership team in the House. “Members are hoping the Senate will kick into gear because the public expects a lot more to get done.”

• “Sometimes I get the feeling that some of those guys [in the Senate] just like to see their names in the paper and see their faces on TV,” says Massachusetts Rep. Jim McGovern.

• “I talk a lot about the psychology of consensus,” says House Majority Leader Steny Hoyer (D-Md.). “Too often, it appears, that the psychology in the Senate is the psychology of one.”

• “When it comes to a jobs bill, the Senate seems more interested in dithering,” says first-year Rep. Tom Perriello, a Virginia Democrat whohas taken heat back home for tough votes on climate change and health care — two issues that remain bottled up in slow-moving Senate deliberations.

• “If you just take a look at the number of bills we’ve sent to the Senate and what they’ve done, I don’t know what they’re doing with their time honestly,” says Rep. Zoe Lofgren (D-Cal.). <<my hero, love ya Zoe

• “I think the majority leader sometimes has to have the leadership to resolve these things,” says Pennsylvania Rep. Joe Sestak, a Democrat challenging Sen. Arlen Specter, in a direct attack on Sen. Harry Reid (D-Nev.). “I understand it’s politically challenging, but we have the votes — and we should be doing much better than we are. I think this place needs a change, quite frankly.”

Digby:

There has been a bit of back and forth about whether or not it's fair to blame Obama for the state of the health care debate , with Yglesias and Klein, among others, saying that criticisms of domestic initiatives should be focused on the congress rather than the president, who has little institutional power to affect it. I think it's true that the congress, particularly the Senate, is the choke point on domestic legislation, but the fact remains that the president is the only one who runs a national campaign and he sets the agenda. And depending on the extent of his mandate, the president has a tremendous amount of power, particularly in the first year of his term, because he has a measurable support from the public. And public opinion, believe it or not, is important.

The White House knows this very well and it husbands its capital, prioritizing the things it cares enough about to spend it on.

********************
Even I knew that the Senate was full of a bunch of prima donnas who had to be deftly handled and given a tremendous amount of attention and engagement when you try to do something big. That's just how it works in that chamber, especially when Democrats are in the majority. It was never going to be easy. But the president had a tremendous amount of good will and political power when he came into office and indicated from the beginning that instead of pushing through his agenda quickly and efficiently he would have the congress to "take the lead" and only inject himself when it was necessary to consecrate some (preferably bipartisan) compromise. That's a recipe for slow action and bad legislation.

The president may not have the singular power to enact good domestic policy, but he is the only one with the power and public backing to knock heads and lead in his own party. And if the best he can do in that regard is tell the Democrats that they need to "protect him" by passing any bill, well, that's pretty weak.

pushing through his agenda quickly and efficiently

what in the fuck

yes, if only he had done that.

goole otm

its pretty clear that a) the President's popularity and b) the public's actual support for a public option/healthcare reform do not count for JACKSHIT in the Senate (at least, this Senate)

knock heads and lead in his own party

which party are joe lieberman, susan collins and olympia snowe in? or chuck grassley, for that matter (remember him?)

really don't understand why the important angle of this discussion is, who exactly bears the greater proportion of blame for the exact amount of shittiness in the bill. eyes on the ball everyone!

ball is deflated btw

better to ask for 10 and get 4 1/2 than demand 100 and get nothing. the GOP wants this deal to come out 0. insurance, pharma and provider lobbies ditto. zero. now howard dean does too? i will not be happy with zero. no deal today means we're done. how in the hell is it a "not worth doing" let alone a "loss"? what in the fuck are these people thinking. do the deal and pick yourselves up tomorrow.

I agree. still angry though.

well no shit! i'm angry but not proud, christ grow up everyone

meanwhile, $1.2 billion in insurance company dividends in new york state alone.

http://1.bp.blogspot.com/_otfwl2zc6Qc/SoMLoWBKM4I/AAAAAAAAK4g/wKdZyg5LxQ0/s1600-h/profits.bmp