There was a time only a few months ago when it looked like health care reform could actually be easy. Obama’s approval rating was sky high. Baucus and Kennedy had gotten all the different industries to the table. A small but noticeable number of Republican senators claimed to be open to reform. Everyone thought the reform train was rolling out, so no one wanted to be left at the station.
Not so long after those first heady months, everything started to unravel. Obama’s approval rating started dropping. The Republican meme that killing reform would kill Obama slowly became party doctrine. Baucus and Grassley failed time after time to make their own deadlines. And probably most devastating, the CBO score came back, and it was bad.
It seemed at first there was hope reform could be a big win-win. Doctors gave a little, Pharma gave a little, insurance companies gave a little and there would be enough to pay to get everyone insured. It seems they were hoping several relatively painless changes like more preventative care, payment structure changes, competitive bidding, electronic records, etc. would have their powers combine into huge savings.
If that first CBO report of health care reform came back at only $500 billion it might all have worked. The medical industries would accept some reforms in exchange for a massive new customer base. Liberals would be forced to give up on the public option in exchange for extremely generous subsidies to the poor and middle class. The bill could have been paid for all through savings or only minor, indirect taxes. A decent bipartisan reform bill would have been quickly passed over some progressive objections.
When CBO director Elmendorf refused to score most of the potential savings the grand coalition fell apart. The knives came out and someone (if not everyone) was going to be the loser. What industries would take a huge hit to their profits? Would liberals be forced to accept very small subsides and getting everyone only bad technical insurance? Would Republicans swallow large tax increases?
When reform went from deal making to knife fighting, Obama lost all hope of easy bipartisan reform. His only hope is to rally his base for an arm twisting partisan bill. The only thing which can rally the base is the public option.
The health care activists tend to be the people who were screwed over by insurance companies or had loved ones that were. They aren’t going to waste their weekends knocking on doors campaigning to give insurance companies huge checks from the government. They don’t want to see the industry be forced to accept some sensible new regulations. They want to be free of them. They want to see these evil companies dismantled.
Some in the media wonder why Obama’s progressive volunteers are not turning out in force for health care reform. The answer is simple. He has made it clear he is not committed to their main goal: freedom from the evil insurance companies.
Progressive activists will not rally around slogans like:
“Several new common sense regulations that end some of health insurance’s worst practices in exchange for forcing everyone by law to pay thousands for their product.” or “Demand subsidy levels be 9% instead of 11% of income for families making over 300% of the FPL.”
If Obama wants to get the grassroots fighting with him for health care reform he needs to make a firm promise that he is not going to sell them out. Every time he makes a wishy washy statement about the public option, says everything must be on the table, and claims private cooperatives might be just as good, it is a blow to the grassroots’ morale. It is Obama telling them he does not need them, does not want them, and will not stand with them.
If Obama wants to rally an army of activists to his cause all he needs to do is publicly say, “I will veto any bill without a real public option.”
Related posts:
- Surprise! Redux: AMA Folds Half-Way On Its Opposition to Public Plan Option; Obama Keeps Up Pressure
- Carolyn Maloney: I’ll Vote for a Bill That Doesn’t Have a Public Plan
- Not Just Sebelius; Obama Told Reporters He’d Compromise on Public Health Plan Option
- Obama to Congress: Insurance Requirement Okay with Public Health Plan Option and Cost Regulation
- Stupak Amendment Would Reach Well Beyond Public Plan, Insurance Marketplace
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Great post. Obama needs to go into campaign mode. Massive crowds holding red white and blue signs that read Public Option.
A lot of very powerful people, well, enough of them are seeing the end to their time sucking at the teat and they are not going to go quietly.
This is not closing a plant with a few hundred poor working stiffs. You are taking it away from the privileged elites who feel entitled to extracting wealth wherever and however they can and want no one interfering.
Welcome to the Lake, Jon.
I agree Obama needs the Public Option, and the Public Option needs Obama.
Presumes Obama wants the public option.
Any significant change will only come from POPULAR demand. You cannot rely on politicians for that. At best they respond to public opinion and ride out in from of that.
We have no visionary leaders who will take us there.
Thank you Elliott,
To quote an old radio line “Long time listener, first time caller”
Obama is trying this team of rivals approach to get the status quo to change if I understand his approach.
This means he gets the other side to come over (slightly and slowly) bit by bit until we are moving in the right direction.
That’s not a real course change, as much as it’s small course corrections. And it’s not a public option because the rival will abandon and worse undermine his administration across the board.
He called it bipartisanship because that sounds like getting both sides on board.
The left side doesn’t care if the right is on board. They want the helm hard over NOW.
Excellent post which explains the current situation to a T
Ya mean he won’t??? Without the Public Option all this wringing of hands is worthless to the American People. We all want to be free of corporate masters who are metering out care… that is if they are making PROFIT!! Then they might cover your medical needs. No profit no coverage.
Profit and Health Care are antithetical of each other! Profit always means that those who paid will at times be denied the treatment they need to stay alive!!
Yep Raise the Stakes we can give Obama the victory is he rallies us. The GOP is using an Obama defeat to rally their troops. The GOP killed bipartisanship when they said that WE want to kill old people.
This happened already with the Stimulus Plan Obama tried to be bipartisan and ran into a screaming wall of lies.
Fool me once shame on you, fool me twice shame on me its not yet time for Obama to feel bad!
We can either go Left and rally the troops or Obama can start making more compromises and get what the GOP wants a program which won’t cover everyone, immediately, and will be run badly.
The GOP needs big government to fail. Obama needs it to work there is no true bipartisanship unless you both agree on certain goals like helping Americans as opposed to just helping the Rich.
I agree that the vagueness of Obama’s “plan” is keeping many activists on the sideline. I have personally met numerous Obama voters who are exasperated by the vagueness of his “plan” for health care reform. Obama’s pattern of claiming repeatedly that his “plan” will save money without telling us how that will happen is hurting his credibility on the health care reform issue with the general public as well.
Obama’s vagueness about the “public option” is especially damaging because all the hoopla about the PO’s cost-cutting power has led Americans to believe the PO is “the heart” of Obama’s plan to contain health care costs.
I disagree that all Obama has to do to mobilize activists is state that he will veto a bill “without a real public option.” I believe that such a vacuous statement will have little effect on activists, and no effect, and possibly a damaging effect, on the general public. Why should the public be impressed by a threat to veto a 1,000-page bill — a bill that will allegedly insure all by 5% of the American public — over some bumper-sticker slogan, some political Rorschalk blot?
Obama has to explain what “a real public option” is, and and then and only then will a threat to veto a bill without one mean anything to activists and the public at large.
I have deep sympathy for Obama. He has been repeatedly advised that the phrase “real PO” and “robust PO” are so information-rich that the mere mouthing of those terms will cause activists all over America to understand why it’s in their interests to give a fig about the aforementioned “robust PO.”
Let’s help Obama out. Jon, tell me how you would distinguish a “real public option” from an “unreal public option,” or a “robust public option” from a “weak public option,” or a PO that will enroll tens of millions of people from a PO that will enroll 3 people? To put this another way, can you tell me what “a real PO” will do, and then tell me what criteria have to be met to create a PO that will do that?
Or let’s try this for a conversation starter: Do you consider the PO in HR 3200 to be a “real PO”? Or how about this: Can you steer me to a document that defines what you would consider to be a “real PO”?
I would prefer that you find ways of expressing yourself that do not rely on HCAN’s abstract talking points. I would prefer, for example, not to hear that a “real PO” will “keep the insurance companies honest.” If you offer that lazy metaphor to me, I will ask you to explain in concrete English what this means, and when we’ve agreed on a concrete defintion of what it means to make Aetna “honest,” I will then ask you for (a) a description of the mechanism that leads to this transformation of Aetna and (b) a description of the features of a PO that can achieve such an outcome.
Let me give you two more examples of HCAN talking points that will lengthen our conversation and force me to ask you to define what the talking point means and describe the mechanism that will lead to the outcome advertised in the talking point. The two examples,taken from HCAN’s blog, are: a “robust PO” will be “national” and have “bargaining clout.” If you tell me your definition of a “real PO” is one that is “national” and has “bargaining clout,” I will ask you what those terms mean and for a description of the features that a PO must have in order to be “national” and have “bargaining clout.” http://blog.healthcareforameri…..rinciples/
Kip Sullivan
Well, for what it’s worth, I also favor a robust pubic option.
How about I will veto any more military funding that is not for bringing the troops home from Iraq and Afghanistan. If the GOP wants war for a year or two more they must deal with me.
Ok change directions we drop the current plan and go with the Michael Moore plan? That should get the base going France, Cuba, England, Canada they all got ideas that are worth while.
Well I consider a real public plan to be at minimum a health insurance program run by HHS or a department of it. The people running the program would be government employees (no foolish contracting, the greatest waste of money Washington invented).
A Robust public plan would be Medicare Buy in. Not only would it save the most money but it would be the easiest sell. Obama should just go on TV and say for the people who can’t afford health insurance I will let them buy into Medicare as long as the paid the full cost of insuring themselves.
Turn the argument from one about a vague “public plan” to Medicare.
Since deals with a bipartisan GOP are out of the question lets show them WHY they should have dealt in good faith with Obama. Every Speech Obama gives and he better give a bunch he says we will tax the richest 2% of Americans to for healthcare.
The GOP will scream No the GOP will offer bipartisan alternatives we refuse to change our mind.
Speaking of Public Options. We already OWN an insurance company called AIG. Let’s put it to work.
If we get our base stoked we already have 76% support our base will keep this story going. The Blue Dogs kill this we will need Obama himself to attack them and the GOP.
Reagan had Abortion we have Healthcare as our own Prolife issue. We keep the fever stoked until the next election. Obama makes sure all the Blue Dogs get Primary challenges.
In other words when the Census is done and we redraw Congressional Districts we will have less Blue Dogs making those Congressional Districts, less GOPers.
But a whole lot of people who rode in on Health Care for everyone.
They are the biggest insurance company still right Obama I think could just run them as a nonprofit and that would be how they pay us back.
If Obama shows he does not need Congress and is seriously considering this the GOP will panic.
There are reports Tea Baggers are going to healthcare meetings and acting like Brown Shirts shouting people down. We are going to have to do something about that. Funny the FBI is not doing a thing just like the GOP Presidential Convention our side even reporters get hassled nothing is done.
Does the GOP really want to see a progun Lefty movement evolve?
Well, now we’re talking about a concrete plan. Opening Medicare up to people who can afford to pay the entire cost of what an actuary thinks they will cost Medicare is definitely a concrete proposal and understandable proposal. However, it will have a limited impact because most of the people who will want to do that — farmers, real estate agents, and small employers and their employees who can’t find affordable coverage from insurance companies — won’t be able to pay a premium defined the way you define it (”the full cost of insuring themselves”). This will be especially true for people with chronic conditions.
Do you realize that your proposal bears no resemblance to the “public option” proposed in the House and Senate HELP committee bills? If Obama were to follow your suggestion, he would have to say, “My fellow Americans, I will not sign a bill that does not contain a provision that opens Medicare up to any member of the public who wants to pay the full cost of insuring themselves through Medicare. What makes this a particularly disturbing threat is that neither the House nor Senate bill contains this provision now, and no one is talking about adding it.”
If you proposed adding all people of a certain age to Medicare, say, everyone age 55-65, or all kids under 19, that would also be a concrete proposal, and it would definitely work. But without subsidies, opening Medicare up to the general public will have a limited impact on the number of uninsured and underinsured.
Kip
What the CBO did not seem to take into account is those of us who are paying for private health insurance and that cost, over against what we might pay in increased taxes. My monthly cost of BC/BS for me and my three children, $2,500 individual deductible and $5,000 family deductible, is $930, or almost $12,000 yearly; it is 25% higher than what I pay in federal income tax. So, if you raise my federal income tax substantially, but let me buy into a public plan such as Medicare, it is at least a break-even deal for me.
Nice post- I’d love to see Obama fight for a single payer plan.
Unfortunately, Obama doesn’t appear to be much of a fighter. I think that he is more likely to lower the criteria for success and call it a day than to fight for single payer or true reform- It’s just going to be easier buying everyone off, and then passing something that has “Health Care” and “Reform” in the title. Everyone then gets to live for another day. Obama can promise more reform down the road, the Republicans can cheer about killing true reform, the Democratic leadership can say they passed a reform bill, and the blue dogs can say they protected their main constituents- the insurance companies. The only losers, as usual, will be the 70% of Americans who wanted the system to actually get better.
I’m sure that when Bush had these same numbers the very talking heads saying Obama is down were saying Bush was doing great or just going through a rough patch.
The DOW has been over 9,000 for a week. Cash for Clunkers stimulated the economy in a week when we thought it would take until November.
If we had details like how much lower drugs would cost hopefully what Canada pays then we could say Microsoft spends lets say 20% of their budget on Healthcare for their employees.
Obama’s plan will save them 7% next year. We need real details to make the real world comparisons we can sell.
This kind of news is what makes stock markets go up. We need to separate the Healthcare industry, Drug and Insurance companies from the rest of American business.
Ok sounds good I like it if higher taxes are coming would you still want private insurance or a public plan assuming its like France? That as a polling question for the well off would be interesting.
I want Michael Moore’s film “Sicko ” shown on National TV in all markets before the vote. I want the FCC to start fining NewsPeople for lying about Healthcare in lies so bad they could not be an error.
So is there any sign that Obama is listening?
I said “robust” would be a Medicare buy in. “Real” just means it is run by the HHS which both the House and Senate HELP committee are.
As to the “full cost” you also need to force community rates. (one price for each age group say 18-30, 30-45, 45-65) So people with chronic conditions could afford insurance. A Medicare buy-in according to the CBO should cost about 15% less than private group insurance. It would probably be about 2/3 the price of what people are paying for individual or small group insurance right now.
Of course all the health reform plans include subsidies to buy insurance.
First you win.
Then you get everything you ask for.
Then you laugh at your opponents.
Then you get everything you ask for.
Then you ignore your opponents.
Then you get everything you ask for.
Then your opponents begin to fight.
Then you get everything you ask for.
They say you aren’t a fighter.
Then you get everything you ask for.
They say your support is fading.
Then you get everything you ask for.
Makes Gandhi’s comment seem out-dated.
When we see the House Tri-committee plan after markup–the three markups have to be reconciled, we will see how far down the road it might be possible to go in Congress. Obama’s problem is that there are only a few members of Congress who owe their election to his coattails although his coattails were substantial; those few are already on board.
So it comes down to the public moving the House bill through to signing. Not progressives, there still are too few of us, but the public.
It is Congress that will make Republicans scream, not Obama. Obama will be talking as directly to the public as he can, given the media blackout on real policy conversations. He pissed off the media by going around them to win election; he wasn’t supposed to win. He is pissing them off more by going to local venues and attracting positive local coverage of his town hall meetings on healthcare. He can keep doing that, keep repeating what the goals are and let Congress hassle with the how. But if they depart from those goals, he must be tough either in private or in public. So far there has been enough progressive and public pushback (thanks to Jane Hamsher, nyceve, slinkerwink, and Mike Stark) to keep the House on track. And several progressive groups are running ads in the districts of waffling Democrats. Mike Ross and Ben Nelson don’t like the ads running in their districts because it points out that they are not working for their constituents. But it is going to be effective.
But this part of Jon’s analysis is on target. Elmendorf by taking a too restricted approach to estimating savings mucked up the public option and provided an opening for his mentor Kent Conrad. I believe when this is done, there will be a number of Democrats who will question exactly how straight-up the CBO analysis under Elmendorf will be.
Republicans have declared this healthcare battle to be a test of their strength. The ability of Democrats to secure the House version of the healthcare bill will be how we can have Republicans fail this test. Now, if the house version has a strong public option, I see no reason why progressives shouldn’t work hard just to slam it through. That means reaching into your rolodexes and mobilizing folks who might not agree with you but might agree with the contents of the House bill. Failure to pass what is likely to emerge as the House bill could mean passing a far worse bill or nothing at all. Nothing at all puts us back in Clintonland; Obama will be tacking more to the right. A far worse bill closes off the possibility for additional reform.
The key parts of the House bill are the strong public option (and you know the Congressional Progressive Caucus definition of that) tied to Medicare plus 5% payments, taxes on the upper 1%, and the independent commission to deal with further cost containment. Those are what we must hold firm on. But all three of these are popular with the public already. So we will be busy debunking all the bullcrap information that Republicans will be putting out about the bill in order to get our friends, family, neighbors, and co-workers to focus on these three things and the reforms that make up the 80% that Obama keeps saying Congress (meaning the Democratic caucus) is in agreement on. And single-payer advocates better be whipping the inclusion of the Kucinich Amendment to permit states to create demonstration single-payer coverage.
Sorry for the length, but it is easy to lose focus on how to turn the politics of this to our advantage and get a bill that can be a platform for further reform by fixating on what Obama has done or not done. He can’t and won’t do the grassroots organizing job that we have to do to move the Overton window in a more progressive direction even in the face of the opposition of the corporate media.
Does anyone find it very suspicious that we can’t have heath care reform at least until 2013, or until after Obama is reelected…REELECTED? We have to guarantee Obama’s reelection before we can have health care reform? That wasn’t part of “Yes we can!”
I unwillingly had to settle for no single payer. I will not be blackmailed into reelecting President Bait & Switch without a robust public option up and running before the end of 2012.
Swine flu is coming it was not contained its not over. The disease has some parts of the Avian flu virus if it effects birds. Also infected people as well as pigs can spread it America eats more meat than anyone.
“Every time he makes a wishy washy statement about the public option, says everything must be on the table, and claims private cooperatives might be just as good, it is a blow to the grassroots’ morale.”
No matter what “bipartisanship” he wishes for, Obama is spitting in the wind if he doesn’t say straight out that the only plan that will save everybody money is single payer–see Canada and France and Germany and the UK. When you try to please everybody, you end up pleasing no one. I hope the progressive caucus votes against any bill hammered out with the blue dogs. Can’t be good, will cost too much, won’t help anybody but the insurance companies. The definition of insanity is doing the same thing over and over and hoping for a different result.
Our meet is handled by big companies who grow pigs, turkey, chickens in huge factory farms and these farms are run by immigrants who don’t have healthcare and are too poor to take a day off of work if they get sick.
If they wait until they are emergency room sick and a load of bad meat gets to the taste of Chicago or even worse bad Turkey’s before Thanksgiving.
We are screwed.
Think about how many Americans visit family on the holidays any holiday not just Thanksgiving and eat lots of meat with Family. Given how many fly in a holiday outbreak in just a few cities caused by bad meat would result in sick people spreading the disease nationwide.
We hope the vaccine companies make a 100% effective vaccine but how often are they just partially effective or not effective at all vaccines? A swing and a miss by the vaccine companies normally makes little news.
A swing and a miss with Swine Flu is a swing and a miss at the World Series.
That’s about it, isn’t it?
I strongly believe Obama personally DOES NOT want anything that even resembles a public option and he never did! He simply does not care about ordinary Americans, and certainly could care less about the Progressive Community. Obama is in this for the “thrill of a lifetime ride”, and is absolutely determined to live this “American President” experience as just a “celebrity fame and fortune lifestyle” to the fullest. I just wish he would have chosen the NBA as a career instead of the Presidency. But of course we all know he didn’t have the ability or skills to play the game at that level, nor does he have the intelligence, or skills to be President.
Obama can’t mobilize his mailing list because enough of them would look at the detail to be skeptical. So, no signage.
You don’t get the flu by eating pork, or poultry, or any meat for that matter. Getting the flu has nothing to do with what you eat.
Yeah, and when you don’t ask for more than enough, you never get enough.
That’s about it, isn’t it?
How about let’s hear your plan for getting past the Blue Dogs in the House. Can’t pass a bill without 15 of them.
Excellent point, aardvark! Lots of people never see this real example of how the tax system works to help everyone.
Every study says America won’t be effected as much by Swine Flu because of our wealth and technology but
what if wealth and technology are the problem? We must challenge fundamental assumptions!
1) We eat more meat than anybody the more bad meat you eat the more likely you are to get sick.
2) Our country borders Mexico where Swine Flu was first discovered
3) We have a very open border and Mexican workers help make much of our meat.
4) This meat is raised in very dirty conditions and the animals are kept close together that speeds the rate of the disease’s transmission.
5) Mexican Workers are not being offered Health Care even under Obama’s plan so if they get sick they being to poor to take a day off work until they get Emergency room sick means that several days worth of meat might be shipped and eaten before we shut the meat plant down.
6) After people get sick from eating meat and the disease is identified as Swine flu meaning more time has passed for the disease to spread the FDA takes forever to track down bad meat and order a meat recall. This gives the disease even more time to spread before the public knows not to eat meat.
7) We travel more by car by plane than anyone thus America can spread this disease faster than anyone.
So…. Remind me again why “Medicare For All” wouldn’t (a) fire up the activist base, (b) be totally talking point and signage ready, and (c) give the Democratic Party a solid popular base for at least a generation?
http://en.wikipedia.org/wiki/Swine_influenza
My bold
Someone…I ain’t sayin’ who, forgot to take their medication.
One step that would be useful would be a lot more coverage of Medicare For All in the, er, non-corporate media. Pressure from the left, you know.
Lots of our precooked mass produced food is not properly cooked all the time accidents happen. Lots of Americans either because they are in a hurry or don’t know any better cooking is a declining skill in this country do under cook their meat sometimes.
Well, I just ate, so the “no risk of infection when properly cooked” is making me a bit queasy. And at the risk of starting another flame war with an unfortunate metaphor, I’m very unclear on the relevance of undercooked meat to the public option or plan. Are you sure you’re on the right thread?
* * *
And I generally do try to take some medication right about now, so…
Now that’s more like it. Instead of pounding Public Option supporters out of pique, you have a sketch of a plan.
2 questions:
1) How do you propose we combat the hundreds of millions that will be spent combating Medicare For All? Can we stipulate that the money spent thus far in opposition to a Public Option (which would force the interested parties to become competitive or die) is small compared to what they will spend opposing Medicare For All (since that plan would lead to their demise)?
and
2) How do you propose we get people to read Medicare For All legislation, since you already suggested that they haven’t paid any attention to Public option legislation to this point?
And the Blue Dogs will care about pressure from the left? Really. Pray tell, why would they start when they’ve never cared before?
I think “forcing” people onto Medicare would be scary to many and unnecessary. I think is should be “Give everyone the choice of Medicare” Or “Medicare For Any Who Want It.” I feel strongly (and so does the Republicans and the insurance companies) that people would slowly start to choose Medicare of their own free will. Vote with their feet. Some private insurance will survice but in a reduced form with real fear of losing market share if they do not focus on costumers.
Even in most single payer countries there is some form of private health insurance.
http://en.wikipedia.org/wiki/Swine_influenza
Either we vaccinate food workers even the illegals for Swine flu and well everything or our mass produced food system’s very efficiency will kill us, sooner or later.
Yes I am on the right thread if we have a plague we will pass National HealthCare very easily which is what this thread is about.
But we will have already suffered the very cost in human life National Healthcare is suppose to prevent.
By covering everyone you get early reports on spreading disease its easier to stop a disease before it has spread Nationally.
And while the GOP is very happy that they have health insurance they see no reason to pay for anyone else to get health insurance.
But the threat of a widespread plague that vaccines don’t work on is I feel our best chance to convince the GOP to see our side on this issue.
There isn’t a base of support for that Medicare as a choice thing. Pete Stark’s bill, Americare, which is the logical vehicle for that idea, has no support and is never mentioned and has no co-sponsors, and Stark isn’t clearly pushing it himself. At least there is wide support for the Public Option across a good bit of society and in congress. Pushing for something that might happen makes a lot more sense than talking up something that won’t.
Rich GOPers like Mitt Romney have Mexicans cut their lawn, take care of their kids cook their meals when they eat out leaving the immigrant population out of the National Healthcare System means the GOP risks the disease coming straight into their homes.
Mexican landscapers, Nannies, Cooks have relatives who work in the meat packing industry and they do visit each other and socialize eat etc.
GOPers who represent areas with meat packing plants are therefore more likely to be at risk.
I say we target them next.
Getting “Sicko” shown on National Tv on a major network Nationwide would be a start. If we had a plan with details the newspapers would cover it although some would not cover it honestly.
I don’t. What Obama needs is “Medicare for All,” and “Medicare for All,” needs Obama.
Play up plague fear is all I got to convince them. Its a very real fear so I don’t feel bad about using the fear card to be proactive about stopping a disaster before it starts.
Not speaking would be worse. Still the GOP and Blue Dogs were paid a lot of money convincing them seems almost impossible.
Sorry. It’s way past time for him to feel bad. He’s screwed up accountability for torture and domestic surveillance, the bank bailout, the credit card reform act, and the stimulus package, and he’s in the process of screwing up health care reform. Obama needs to quit channeling Bill Clinton and start channeling FDR, Harry, and LBJ (at least in domestic politics). He’s using the wrong models and the wrong personnel at the White House. He needs a lot of other things too, but I’m already off the subject.
I give you tremendous credit. That’s the first actual plan anyone has offered. I’m not sure the connection would be immediate among people in their districts, but at least you’re thinking along the right lines.
Here’s a thought exercise. What do the Single Payer cosponsors have that the Blue Dogs want?
If you can figure out an answer to that question, you’re on your way to a plan.
dunno if mobilizing voters to call/write/fax/picket their congress critters would have turned enough blue dogs or not, but obama could have mobilized tons of citizens if he’d promised them health care, free at the doctor’s office of their choice, free at the hospital of their choice, no matter what their employment situation, no matter what the size of their bank account, pre-paid with a modest increase in taxes.
The votes to keep the wars in Iraq and Afghanistan going after all if we can’t afford National Healthcare and that is what the Blue Dogs and GOP all say they care about then lets end both wars now.
We have 76% support on National Healthcare lets focus all that energy against the war present it as an either or choice to voters with polls.
Either we get National Healthcare or we have a few more years of war in Iraq and Afghanistan. Now then just what do you think the voters will choose?
Nope we still got time we can push him Left as Jon Walker suggests either Obama goes Left to get things he wants passed or they are not going to pass.
Obama tried bipartisanship it failed lets see how long it takes and if he can learn from his mistakes.
We already had 8 years of one president who never admitted a mistake until it was to late to do any good. I am hopeful we did not elect another.
I quite agree with everything that Kip has offered here. But, in addition, in reply to:
I need to say that I think this is considerably off the mark. He just won’t get a movement going around the public option, because the message using the idea will be too blurred and indistinct for people to understand. The only message which can rally the base is “Medicare for All,” because that’s the only one that can be communicated well to large numbers of people at this late date. The argument is in more detail here.
Right. But do it on a universal basis. No public option. No insurance companies for basic care. Medicare for All.
“forcing everyone into medicare”
that people are afraid of change idea was just that, an idea. it was never a proven fact.
yes, other countries have private insurance, and hr 676 would allow that too — as a top-up for whatever the new, improved medicare did not cover. this is how canada does their medicare.
i live in a very red part of a purple state, rabidly partisan teabagger republican, but it only takes me a few sentences to explain how medicare for all would help them, what it would cost them, and what it would give them that they don’t have now [assuming they even have insurance]. about 2 out of 3 people i talk to say sounds good, where do i sign up?
I’ve had the same experience a few red staters in Seattle:)
Good reply.
But that is exactly my point. Give the people the option to sign up for Medicare. I’m sure that 2/3 of people like the idea, but that other 1/3 can really throw a hissy fit. I think a Medicare Buy in is a much easier glide path to something like single payer.
Medicare for all, Universal Healthcare agreed raise the stakes the public option was a compromise. When compromise fails get a Hammer or be the Fox and the Lion as Machiavelli said.
A promise to Veto all Military Spending except to bring the troops back home until we got a Good Medicare for all, Universal Healthcare bill passed would be a great motivator for the base.
We want peace and healthcare. When the GOP says what about the public option we say you killed that we offered to be nice we offered the hand of friendship.
You spit on us so here is the Fist of No Bipartisanship! Now then do you want somemore?
You said:
And if a bill with these features doesn’t emerge from the Conference Committee, should we then whip to defeat the Conference bill? The question I’m asking is: how depleted does the PO have to be before we say no deal, we’ll try again next year when people hare the insurance industry even more. Folks, this isn’t 1993 anymore. The insurance industry is becoming ever more intolerable. Time is on our side if we hold firm. But if we accept anything and call it a strong public option, what we’ll get is more discrediting of Government, more disillusionment, and a Republican return to power because the Democrats and Government haven’t much improved their lot.
Hi Jane, No one is saying that “Medicare for All” will by itself get the Blue Dogs voting the right way. But the combination of increased intensity of support for “Medicare for All” in their districts, with a warning from Obama that if they vote against him on this, they’ll be absolutely alone in their effort to get re-elected — no party support at all, and even the possibility of active Obama support for a primary challenger, should do wonders for their willingness to be cooperative.
nope, you want us to buy into medicare at full price, whatever it would cost to treat us. if i could do that, i could get private insurance. it would need to be medicare for all, all at once. you could maybe set it up so that for 3 years, or 5 years, they can choose to keep their private insurance, with the option of dropping their insurance and going into medicare sooner if they want, but you’d still have to start collecting the full tax amount from day one, from everyone, to keep medicare alive.
most people really do not care where their insurance comes from, they want to be able to take their kids to the doctor when they get sick. they want to be able to take themselves to the doctor if they get sick, so they can get well and be there for their kids. my point was that if i, a mere mortal, can convince 2/3 of a conservative population to be liberal, then someone with oodles of money and marketing voodoo [hcan, moveon, ofa, david axelrod, obama himself…] can tackle that remaining 1/3.
sounds like a plan to me!
Jon, I don’t agree that Medicare is scary to many people, at least relatively speaking. That is, there may be many millions who’d be scared by “Medicare for All,” but I expect that even more are afraid of the PO because they don’t know what it is and also because they’re beginning to think it’s “socialized medicine.” But they know that Medicare is not “socialized medicine,” but only the system of health care that their parents and grandparents refer to as “their Medicare” which they want the Government to keep its grubby hands off of.
And, if people want to use private insurance after “Medicare for All” is passed, we can certainly give them that choice. We ought not to prohibit private insurance. I just don’t want to charge working people full bore for Medicare, simply for the sake of keeping the private insurers in business. We’ll still need subsidies for people who can’t afford Medicare.
I think you are going in circles. That is why you don’t call it a public plan anymore.
You can it a Medicare Buy in. It is less scary. I support a Medicare for All. I just think creating a bill in which people can sign up for Medicare will get you there faster.
Frankly if you have the “Medicare for All” plan you want, but allow people to opt out. It is not going to produce a very different system than one with subsidies and a Medicare Opt in.
Why would a Blue Dog sitting in a R+22 PVI district care what Obama thought? Most of the people who live their districts don’t even believe he was born in the United States.
And Obama doesn’t believe in those things. Why would he offer them? That’s not really a strategy, it’s a hope.
Again, why would Obama do that? He doesn’t believe in it, didn’t campaign on it — and I can think of about 3 Blue Dogs who would be in trouble if he didn’t endorse them. For most of the rest, it would probably be an advantage.
Oooh! You were so close. And then it went all wrong.
The public likes the war in Afghanistan. They’re not throwing anybody out of office over that. It’s one of the lowest priorities when they poll voters about issues that are important to them.
But you are definitely on the right track. Think about the numbers. A majority in the House is 218. There are 85 single payer cosponsors. Come on, you’re almost there. You’ve already proved you have twice the IQ of anyone in this comment thread, including me. You can do it.
Here’s a hint: Big Ag
If Obama can put pressure on progressive members of Congress, he can put pressure on Blue Dogs too. The evidence is that he has made no effort to do so. A progressive sitting in a solid Democratic district shouldn’t have to listen to Obama either but under pressure they do. How will we know if Obama never makes a serious effort.
As for the Medicare buy in, as has been pointed out, nobody has actually brought this up, not in Congress in the bills, and not Obama. Obama could help the PO a lot by simply telling people what it is. It still has no content. When Obama wants something he is not shy about going after it. His silence on the PO speaks volumes.
There’s no support for “Medicare for All” because Obama took it off the table and Democrats in Congress decided to go along, except for a few recalcitrants like John Conyers and Bernie Sanders. In addition, progressive groups like Move-on have gone along and are not pushing single payer. Still further, the corporate media has devoted very little time to it, because “it’s off the table” and many in the blogosphere have also decided that SP won’t sell. The whole thing has been a self-fulfilling prophecy. The progressive movement and the President have outsmarted themselves in much the same that the Clinton wonks outsmarted themselves. Harry Truman’s effort at National Health Care was defeated 60 years ago. Times have changed. All the facts and experience, both heere and abroad, and most of the stories, are in favor of “Medicare for All.” Let’s go sell it and forget about the PO. It was just a distraction, after all.
They don’t have to read “Medicare for All” legislation. All they have to understand is that they’re going to get Medicare just like their Parents or Grandparents have. Then they ask their Parents or Grandparents about it. 86% of Medicare recipients will tell them good things. If they must read the legislation, they can probably do that too and understand it. HR 676 is only 30 pages.
I do not know what you are talking about.
The House Bill’s orginal public plan (which passed two house committees) was a Medicare Buy in. At least close enough. Used Medicare network (with opt out for doctors) and paid Medicare rates plus 5%. Rockefeller also offered a Medicare Buy in public plan.
The dirty secret of this “level playing field” public plan is it might be the same or even better. There is nothing stopping the Director of the public plan from just dictating rates like Medicare does. In fact there are several things that Medicare pays way too much for and way too little for. (This is because Congressmen slip in pork into the payment system and of course the stupid Part D) The “level playing field” plan would have the freedom to possibly correct these.
Jane, I think it’s the wrong question. The question really should be what do the Blue Dogs need to do to get re-elected?
The answer to this question changes depending on the political environment. If the Administration joins progressives in selling “Medicare for All,” the environment will change. For one thing, health care reform will now be something that people can understand all over the country. For another, the Administration will have taken a position and can threaten the Blue Dogs using every tool at their disposal.
Can the Blue Dogs get elected without the President, and without the DCCC? I doubt it. What are they going to run on, that they defended their constituents from “Medicare for All,” because they were worried about the cost of that, but not about the cost of the Wars, and the bank bailouts.
Good luck trying to sell that one Blue Dogs, or Republicans for that matter.
Three points. I spent five years in managed mental health care as a gate-keeper; I believe I did so in an ethical and professional way; I believe I approved care that was reasonable and appropriate. We were immensely profitable. When I was reprimanded for putting quality of care ahead of profits and told that only a naive or novice manager would put quality of care as his first priority, I moved on. In an HMO, it is not the insurance company that restricts care, it is the physician. Why? Because the physician will have to pay out of his/her pocket for referral to a specialist. Most folks have no clue as to how HMOs work. Hospice is an outstanding example here. I know many good folk who provide hospice services; fact is, almost all hospice are now for-profit HMO corporations; they are very profitable–that is why there are so many of them–and they make their profit by limiting services provided; and they are mostly owned by physicians.
Which brings us to the elephant in the room no one wants to talk about. Physicians expect to make far too much money. I am a health care provider (psychologist), who made an 11 year college investment in his education, not including post-doc. So, I have pretty much the same time investment as any physician; yes, it did cost me less; at the same time, the tax-payer footed about half of the cost of my education, just as the taxpayer footed the bill for half of most physician’s medical education; and if they did a residency at most programs, the taxpayer funded their stipend. I do not get to employ “physician extenders” such as ARNPs or PAs, for whose services are reimbursed as if the services were provided by the physician; these folk are paid a salary by the physician, the standard of which is 60% of reimbursed. Not a bad gig for the physicians.
I make a decent living; in that respect I have no complaint. And, I really like what I do (providing psychological services in nursing homes). But, I make far less than physicians who have no more time investment in their M.D. than I have in my Ph.D. On the average, do they take on more risk, a very popular argument. Well, actually I think that risk increase is marginal. See, I am the one on the hook to affirm life ending decisions by the elderly. I am the one the physician consults to ensure the resident is competent to deny a feeding tube or other “life” sustaining measures.
The issue of end of life care is really not as complicated as it seems; in general, in my experience, what complicates end of live care is the family, irrespective of a living will or the wishes of the patient.
DM
I know what they may choose, but I don’t think the progressives would be prepared to risk it, in the framing that you offered. What’s needed is recognition that Iraq is no longer our war, and that it’s up to them to stabilize their own nation. As for Afghanistan, I think the problem’s in Pakistan now anyway.
I agree with that. That’s what I had in mind by saying that he already ought to be feeling bad. He may be performing very well compared to Bush 43; but when viewed in the context of the needs of our country, he is falling far, far short of what we need. By now, he ought to be realistic enough to recognize that, and not listen to those who will provide him with various excuses about why his poll numbers are falling.
If we can determine how many would throw a hissy fit, that would be good. My view is that only 5% will really do it, and that 1/3 is way over-estimated. If 1/3 were to throw a hissy fit I would go with your view as long as the people who did select Medicare had subsidized insurance. But if poor people had tp pay full bore, I’d be opposed. If only 5% would throw a hissy fit, then my view is that they can buy private insurance if they want it.
Where is this original House bill now with its public Medicare buy in option? Because I have heard nothing on it for weeks and I feel that as strongly as the public option is being pushed at this blog, that many of the posters who support a PO who have mentioned it frequently.
I entirely agree, Hipparchia.
I think the problem with our new President is that he went to College during a period when market fundamentalism was riding high. He believes in the market, and he feels funny about extinguishing markets, so he doesn’t feel entirely comfortable with Medicare for All.
I’m much older than he is. When I went to College, it was well-known that markets didn’t work without regulation and that monopolistic markets shouldn’t exist because they exploited consumers. That knowledge is coming to us again the hard way. But Obama hasn’t quite bought it yet. That’s why he prefers Geithner and Summers to Krugman, Stieglitz, Galbraith, Dean Baker, etc. and why he’s moving so slowly to fix the non-regulation problems.
I feel it is extremely important to recognize the politics that are being played here. Obama has not pushed the public option very hard. In his healthcare news conference, he only mentioned it in response to a question. It was not to be found in his prepared statement. Until the progressives rebelled last week, Obama et al were getting ready to kiss it off with Gibbs’ saying that Obama had no preference between a PO and co-ops. Obama still hasn’t said what this PO will contain, and I don’t think he has mentioned a Medicare buy in, which you might expect if that was even remotely the plan. As for the Blue Dogs, it is largely a myth that they can’t be pressurized. I mean look for instance at who Obama’s Chief of Staff is, Rahm Emanuel. He helped against our advice to get a lot of these loons elected. If anyone knows their weak points and how to get to them, he should. The Senate still wants no public option so it isn’t clear yet that there will be a public option. Since the progressive revolt, its chances have improved but the odds are still in the absence of any leadership by Obama that it will be very weak. As for the House, much will depend on which bill is chosen to be the base bill.
Re my previous comment that should read: would have mentioned it frequently
“If the administration joins the progressives in selling health care for all…”
Why would you think they would do that? It’s not Obama’s platform. It’s not what he believes. It’s a complete fantasy. It’s not going to happen. It’s like saying “If George Bush joins the progressives in stopping the war.”
Nice thought, just not grounded in reality.
It is clearly spelled out in the info sheet about the original House public plan. It is strongly based on Medicare. If not technically a “Medicare buy in” at least buy into something very very close. http://waysandmeans.house.gov/…..option.pdf
Or you can read the bill your self starting on page 116
http://waysandmeans.house.gov/…..001xml.pdf
In fact that is what the Blue Dogs were complaining about. The did not like that it was basically a Medicare Buy in.
Jon, Thanks for your reply. Perhaps you’re right that both would amount to the same thing. We’d have to look more closely at the details.
What we call it is important though. If we call it “Medicare for All,” everyone understands that. If we call it a Medicare Buy-in, there are different implications, and exactly what we mean is not so clear to people.
After the experience of the past few months what we need now is clarity in messaging, I think that is supported better than “Medicare for All” with an opt-out, than Medicare available with an opt-in.
Once the laws are implemented, the marketing is very different too. With Medicare for All there’s much less need to market it than there is in your suggested implementation. BTW, I don’t think the terminology “public plan” has been a winner, and I see no advantage in retaining it, if we’re talking about some Medicare variant.
Big Agriculture Farm subsidies to factory farms All those Ethanol companies went broke I think there is only one still running the price of corn should drop like a stone. Obama is too nice to Cuba, Cuban sugar well consumers want it, health nuts know its better than corn syrup, is linked to diabetes and Hispanic voters do worry about that. Brazil can flood our markets with ethanol made from sugar and sugar.
Also America no longer has any big candy makers left Brach’s left Chicago during the Bush years because sugar is to expensive.
The Blue Dogs want a Deal on Corn.
Plus if Obama weakens the Organic label big Food will be able to charge Organic prices for their crap.
I’m sure big food wants some other stuff too but I’m out of ideas.
Jane, the predicate of Jon’s post is that Obama needs to change what he likes or his health care is going down as are the Democrats in 2010. If Obama doesn’t agree with that predicate, then, of course, he won’t change. But if he agrees he needs to change, then the question comes up as to whether he’s better off trying to sell a very strong public option, or “Medicare for All.” For me that’s a purely rhetorical question since we already know that the public option doesn’t excite regular people (even though 76% say they support it, the intensity of their support is evidently not very high) and also doesn’t excite many in the progressive movement.
Fine. Do they care if they get any money from the DCCC or any of the progressive movement organizations?
Okay Hugh is officially the smartest one in the room. Yes, Rahm has leverage with the Blue Dogs. That’s the part of the public plan whip to pressure the Blue Dogs — “make Rahm work for you.” Obama campaigned on the public plan, and a bunch of progressives did too. Make them feel the pressure of the distance between their words and their actions, and form a 40 vote firewall. Make Rahm pressure the blue dogs or or fail.
But we were talking about how “single payer or nothing” folks could develop a strategy to pressure the Blue Dogs. Since Obama didn’t campaign on single payer and Rahm doesn’t give a shit, nor will he, that’s not going to work there.
Just trying to be helpful. Here’s another hint. The Kucinich amendment will probably come to the floor. At that point, what can 85 cosponsors of 676 do to bring Congress to heel if they don’t get the support to pass it?
Come on, TCU. You were almost there.
He’s not. Going. To. Do. It. Today the WaPo said he’s not committing to any specific language on health care so he can take credit for anything that passes. He does not share your vision of the future.
If they can get elected without the National Democratic Party, then more power to them. However, I don’t think they won in the last election by divorcing themselves from the Democrats; and without support I don’t think they’ll win in the next. As I said earlier, how will they sell the idea that they opposed “Medicare for All” because they thought it was too costly? Again, if they win with that, more power to them, and woe is us.
Hugh, What does it speak volumes about?
Their biggest donors are labor. The DCCC loves them. They don’t care how much you bellyache, the DCCC thinks they owe their expanded majorities to kissing the ass of Blue Dogs. Chris Van Hollen is not going to wake up tomorrow and tell them all to get stuffed because he saw the single payer light on the road to Damascus.
Come on, this is serious. People’s lives are at stake. Being “right” about the war in Iraq was not enough to end it. It’s not enough here either.
Think.
Why would a Blue Dog sitting in a R+22 PVI district care what Obama thought?
uh, because obama is the boss of rahm and rahm is the patron saint of blue dogs?
Most of the people who live their districts don’t even believe he was born in the United States.
oh, i can top that. most of the people here still think he’s the antichrist. but they’d like to have medicare, and they’d re-elect the legislator that got it for them. dunno if they’d re-elect the legislator that makes them wait 4 years for something they can’t understand and can’t afford but have to buy anyway and hope that it helps them.
And Obama doesn’t believe in those things.
it was obvious early in the primaries that he didn’t believe in these things. or in ending the war, or in fisa protections, or …
Why would he offer them?
pitchforks. torches.
That’s not really a strategy, it’s a hope.
ah yes. well, let’s pass a bill, any bill, and hope that we can fix it later if it doesn’t work as advertised, and let’s hope that all the people who need medical care can hang on until 2013 or later is at least a strategy. sucky policy, but it’s a strategy that could work if you can get the bill passed quickly enough to keep most of the populace from finding out that it’s not going to help them as much as is being promised.
Big Agriculture wants more crop support money and and Any big trade deals coming up soon? Maybe they want reassurance That NAFTA and other trade treaties in this tough economic climate won’t be modified to protect workers and the environment trade barriers would be politically popular we could pass them easy.
The last thing they want is trade wars.
18 of the 28 Dems on the House Ag committee (biggest bunch of crooks in the House) are Blue Dogs. They only pass the farm bill once every four years, BUT — they pass a supplemental appropriations bill every year.
It’s my post for tomorrow. It grew out of a long email exchange I had with David Swanson. You have 85 cosponsors of 676 to work with. If they want to unite and wield their power, they can certainly do it.
Now, there would be some DRAAAAAMA and a huge showdown with the conservadems, but if the 676 cosponsors are willing to walk the talk, that’s a small price to pay.
Jon, Not sure about your details here. The original House Plan restricts the public option to a relatively few people, and doesn’t start it up 2013. CBO estimated that in the first few years it would only enroll 10 million people. That’s very different from medicare for All. Btw, Medicare for All would mean we have no need for the exchange aspect of the Bills under consideration now. Since this is one of the more complex aspects of the bill, and one of the aspects most subject to gaming; it’s also a big reason why an opt-in Medicare-like public option won’t work as well as an opt-out Medicare for All.
So close Arrgh! But good news we have leverage! Any inside word if they are going to walk the talk? What time is the post up I’ll try and be there. Good talk Jane I’m heading upstairs.
Where are your pitchforks and torches?
You think Obama’s cowering in some corner of the White House because what — you’re making such a fierce showing in our comments section?
Yeah, I hear Axelrod has a whole team sweeping over every utterance, fearful you’ll take it to La Figa and then it’s all over and he’s a one term wonder.
Well, Jane, now I think we’re going just going around in circles. You say it’s fantasy. I say “yes we can.” Obama is not Bush, and he can be persuaded by a movement. As I’ve been saying here all week, if we try to get one going and have at least some success that is the best thing we can do for a stronger public option.
Well, I suppose I am in the single payer or nothing camp. I do not see any of the bills or any likely final bill doing anything to control costs. So with or without a public option, I don’t see any of this working. The system will remain economically unsustainable. The economy is likely too to nosedive in 2011 so we might see a fairly early revisit.
Actually if the economy tanks in 2011 or before, he will be a one-termer.
I’m in the lets just steal France’s healthcare plan camp:)
Obama’s failure to enunciate what a public option would be and to support it, heck even to mention it, are all indications that the public option is not a priority. Given everything that the insurance industry, BigPharma, and the medical industry are getting out of this, it looks more like a figleaf to justify a giveaway.
You think Obama’s cowering in some corner of the White House because what — you’re making such a fierce showing in our comments section?
nope. i’m here in hopes that not all of your readers have been cowed into believing that they have to settle for the ‘public option’ and that, upon reflection, some of them will be moved to reach for their pitchforks.
i’m in the gonna have to move to france to get healthcare camp.
Right. And he certainly won’t do it, if everyone accepts that he won’t and doesn’t howl loud and long.
So we have a choice, we can accept that he won’t and work for another alternative or get on with other business. I don’t like HR 3200 well enough to support him on that bill. I don’t think it’s a good bill, because the PO is much too small. I don’t think a bill like that will be seen as much of a victory, and if that’s what we get, I think the chances are good we’ll lose many seats in 2010 and that Obama will be defeated in 2012, since the public option won’t even be available until 2013. The succeeding Republican Administration just won’t implement the Reform.
So, I guess I’ll keep trying to persuade people that Medicare for All is the way to go, as I said in another comment, that shouldn’t hurt your attempts to get a better public option.
Yes, thank you for the links. This is the part in the summary that mentions Medicare.
So Medicare payouts are used as a basis but are not the final word. Why not? Why not at least as good as Medicare? If signing on to the public plan is restricted, there won’t be the market share for the public plan to negotiate good prices on services, and, of course, it is not clear what services would be covered. Will the range be the same as Medicare? Perhaps you know. I don’t.
This seems to me to be a killer. This means that a public plan can’t be competitive with private plans short of massive subsidies since it includes fees to build up reserves that private plans already possess. So the idea that a public plan must be self-sustaining would be a fiction. This likely would also act to pressure reductions in coverage making it more bare bones to come in on budget.
Jane, I am thinking. I’m thinking that the present bills aren’t worth a tinker’s damn and that there’s little support for them, and that the support they have is falling because the public option has not captured anyone’s imagination.
So face it. It’s not working. Change direction before we get a bad bill, that is worse for us than no bill at all because it proves that Government is ineffective.
Or let me put this another way. Let’s say we could get HR 3200 as is. Why do you think that improves our present circumstances, that people will like the bill, and that we’ll be able to get enough support on the basis of passing it that we’ll be able to improve it over time. I’m not opposed to the incremental approach. I recognize that the ideal can be the enemy of the good. Just show me that an incremental approach is feasible now and that something like HR 3200 is “good.”
it’s NOT a medicare buy-in. if the blue dogs think it is, they didn’t read the bill. more likely, they know it’s not a medicare buy-in, and also know that painting it as such wins them points with the big-money donors they hope will back them in their next race.
One more thing. I’m all too aware that people’s lives are at stake and bankruptcies too, and broken families too. Now just how will HR 3200 stop all that, and when? If you can show me how, I’ll support it.
And it’s high time that he stopped tell us that. He needs us, whether he wants us or not, and we can all hang together, or all hang separately. If he wants to succeed here, and not be a failed one-termer, everybody hanging together is the way to do it.
Fact is, the biggest and most immediate, though hardly sufficient, benefits of HR 3200 — particularly, elimination of preeexisting condition clauses and most recissions — have nothing whatever to do with the public option and were part of the deal struck with AHIP since last fall or before….in exchange, of course, for insurance-purchase mandates partially subsidized by taxpayers.
I want to go back to a misconception embedded in tarheeldemocrat’s otherwise fine comment @31:
The public option in HR 3200 bears no resemblance to the CPC robustness criteria. CPC called for a public option built out of the existing Medicare infrastructure (instead of creating, at ludicrous expense, essentially a separate free-standing nonprofit insurance company) and a public option “available to all individuals and employers across the nation without limitation.”
I realize that the CPC’s defense of HR 3200 against the Blue Dogs on Thursday counts, by degraded Washington standards, as courage, but we need to remember that they were not standing up for their own robustness criteria (much less single payer) but were merely defending a mediocrity from a venality.
The public plan gets a massive start up loan for its reserves. The whole point is that a public plan can out compete private plans. It does not need subsidies, beyond a generous start up loan.
And as to Medicare payment rates they are far from prefect. One great example is home oxygen. Medicare pays for tanks to be delivered but not to rent people oxygen machines. If you need long term home oxygen it is way more cost effective to buy/rent a oxygen machine.
Hamsher writes:
Er, no. Several like-minded people who were previously unknown to each other have discovered each other through their comments here, and may be able to work out how to take action for themselves on an issue of great interest to the left. That used to be how the blogosphere worked. Have you considered embracing it?
One very good operational test for whether that’s true: Wailing and weeping and gnashing of teeth from the insurance company CEOs that they’re being put out of business. And then another round of it, because the first round will be kabuki. I haven’t heard any of that.
Any enrollment figures on this? So we can hold people accountable and avoid another bait and switch?
Of course it will! After 2013…
Strange bedfellows. [slaps forehead. Ce n’est pas mon métier…]
Is the whip software open source? Serious question.
How the heck do I track comments here? I can’t find the link.
Hi ralphbon,
I agree with all portions of your post, but highlighting:
the question I was asking Jane, stated in expanded form, is:
Is HR 3200 with its elimination of pre-existing conditions and most rescissions and other improvements and also a public option that is most likely to fail, an insurance exchange whose workings according to the bill are quite obscure, along with (probably unenforceable) mandates for individuals and small business, what will probably prove to be inadequate subsidies from the Government, and a start date for the exchange and the public option of 2013, a bill that moves us down the road in a sustainable way, or does it primarily represent a giveaway to the insurance companies that will undermine our political capability to change it later?
And when is later, is it next year or the year after that, or does this bill, in fact freeze health care politics for at least 5 years until people can begin to see that the PO won’t work?
In short is HR 3200 good enough to work for and support; or should we work to defeat it instead, and bet against the smart money’s view that if we fail here to pass any bill, we won’t get another chance at health care reform for many years?
Jon,
I think we’re talking Apples and Oranges here. Can the public option as it exists in HR 3200 right now, for example, be competitive with private insurance? Your alternative public option concept might prove successful and I’d certainly accept it as a fall-back position with a glide path to “Medicare for All,” however, it’s not on the table now. In fairness, your post says that what Obama needs to do is to place it on the table and place all his effort behind it. But my view as developed here is that it would be better if he places “Medicare for All” back on the table because that idea is easier for people to understand and therefore is easier for him to sell. I’ve seen nothing in this extensive discussion to persuade me that my proposal is in error.
There’s a good analysis of HR 3200 here. It supports my view argued in my previous multiple exchanges with Jane Hamsher.
Except for the people who can’t afford the buy-in full boat amount, eh?
Which, with downsizing, unemployment will be a lot of people.
A couple major points of Medicare for All is coverage and subsidies.