Originally Posted by Odin

I still cannot support a mandate without a strong public option and STRICT regulation of the insurance industry. Sorry guys, I just can't.

And on a slightly odd note, Odin and I agree on something... almost.

For me, though, I guess it is a bit simpler.

I still cannot support a mandate.

People should not be forced into it, but its availability should be better provided. If they don't take it, then they should have to live with that choice.

Ezra rips the whole "I don't want to pay" anti-mandate 'thinking' to shreds.

First, responding to Firedoglake's Jane Hamsher's "10 Reasons to Kill the Bill,' he puts the number of people actually impacted by this in perspective -

http://voices.washingtonpost.com/ezr...ns_to_kil.html

1) Forces you to pay up to 8% of your income to private insurance corporations -- whether you want to or not.

"You," huh? For the 85 percent of the country already covered by health-care insurance, it doesn't force "you" to do anything at all. People on Medicare are not going to be paying money to private insurance. People with employer-based care will not see their situation change.

For the nearly 50 million Americans caught in the ranks of the uninsured, here's the deal: The bill expands Medicaid, a public program, to cover about 20 million of, uh, "you." Private insurance gets nothing. If you make more than 133 percent of the poverty line, but less than 400 percent, there's a huge system of new subsidies to help you afford private coverage. There are also new regulations on insurers forcing them to spend between 80 percent and 85 percent of every premium dollar on medical care, barring them from rejecting you or charging you higher premiums due to preexisting conditions, ensuring they can't place any annual caps on insurance benefits, and more.

But here's the catch: So long as insurance won't cost more than 8 percent of your monthly income, you have to buy into the system. You can't wait until you get sick or get hurt and and then buy insurance, shifting the costs onto everyone else. The cost of having a universal, or near-universal, system is that people have to participate. The promise is that, for the first time, participation will be possible.

2) If you refuse to buy the insurance, you'll have to pay penalties of up to 2% of your annual income to the IRS.

Again, who's "you?" If you don't have employer-based coverage, Medicare, Medicaid, or anything else, and premiums won't cost more than 8 percent of your monthly income, and you refuse to purchase insurance, at that point, you will be assessed a penalty of up to 2 percent of your annual income.

Klein forgot to mention the kids between either 19 or 22 (in college) who will be able to stay on their parents' insurance now until 26 and not face any penalty as a result.

But where he really puts a stake in the heart of this Glibertarian bullshit on the mandate is here -

In return for that, [i.e., the 2% penalty] you get guaranteed treatment at hospitals and an insurance system that allows you to purchase full coverage the moment you decide you actually need it. In the current system, if you don't buy insurance, and then find you need it, you'll likely never be able to buy insurance again. There's a very good case to be made, in fact, that paying the 2 percent penalty is the best deal in the bill.

Read that bolded, underlined sentence until you finally GET IT - particularly my Xer pragmatic friends!

Essentially, the 2% penalty may be the BEST DEAL in the whole fricken bill!

For 2%, YOU ARE GUARANTEED TO BE ABLE TO GET INSURANCE COVERAGE OF ANY ILLNESS OR ACCIDENT SHOULD YOU DECIDE THAT YOU NEED IT.

I realize some of you are young, maybe inexperienced in personal finance particularly risk management, perhaps even predisposed to Glibertaian mythological bullshit, but really,….
…. ARE YOU FRICKIN MORONS?!

More explanation here -

http://voices.washingtonpost.com/ezr...te_is_too.html

The individual mandate is too good a deal, not too bad of one

http://tinyurl.com/ylzrt37

Health Care: Dear Senator Reid
Dear Senator Reid:

We write to thank you again for your leadership in the Senate health reform deliberations. We greatly appreciate the important elements of fiscal sustainability that are included in the Manager’s Amendment.

Among the features that we believe to be critical to a fiscally responsible approach to health reform is a more effective independent Medicare advisory body. The Manager’s Amendment has strengthened the role of the body, now called the Independent Payment Advisory Board. The Amendment gives the Board the authority to produce annual reports beginning in 2014 and to report on privately financed medical care as well as care financed by Medicare. In addition, its recommendations will receive fast-track consideration under a broader set of circumstances than under the Senate Leadership Bill. These are important steps toward assuring that health care reform will significantly reduce health care inflation in both the public and private sectors.

Another feature that has been strengthened is the commitment to delivery system change. The Manager’s Amendment contains several provisions that should stimulate the development of innovative approaches to payment for care. These approaches hold the promise of improving quality and lowering the costs of care. Specifically, the Manager’s Amendment includes an expansion of Medicare pilot programs and provisions for bundled payments for a larger set of conditions. These aspects of the proposed legislation make it far more likely that health care providers will have the tools and incentives to deliver better health outcomes.

As a nation, we will need to do more in the coming decade to promote the efficiency and quality of health care. The Manager’s Amendment includes important features that will move our nation’s health care forward while helping to control health expenditure growth. We are grateful for your ongoing efforts and the improvements in the Manager’s amendment. We urge expeditious enactment of your reform legislation.

Sincerely yours,

Dr. Henry Aaron, The Brookings Institution
Dr. Stuart Altman, Brandeis University
Dr. Kenneth Arrow, Stanford University, Nobel Laureate in Economics
Dr. Gary Burtless, The Brookings Institution
Dr. David Cutler, Harvard University
Dr. Patricia Danzon, University of Pennsylvania
Dr. Angus Deaton, Princeton University
Dr. Brad DeLong, University of California, Berkeley
Dr. Peter Diamond, Massachusetts Institute of Technology
Dr. Victor Fuchs, Stanford University
Dr. Alan M. Garber, Stanford University
Dr. Dana Goldman, University of Southern California
Dr. Jonathan Gruber, Massachusetts Institute of Technology
Dr. Daniel McFadden, University of California, Berkeley, Nobel Laureate in Economics
Dr. David Meltzer, University of Chicago
Dr. Joseph Newhouse, Harvard University
Dr. Uwe Reinhardt, Princeton University
Dr. Alice Rivlin, The Brookings Institution
Dr. Meredith Rosenthal, Harvard University
Dr. Isabel Sawhill, The Brookings Institution
Dr. William Sharpe, Stanford University, Nobel Laureate in Economics
Dr. John Shoven, Stanford University
Dr. Robert M. Solow, Massachusetts Institute of Technology, Nobel Laureate in Economics
Dr. Laura D’Andrea Tyson, University of California, Berkeley

Now that should give pause to even the most hard-headed, hate authority Glibertarian.

Originally Posted by writerGrrl

To all people here who support getting rid of the filibuster:
Are you actually going to continue this support if and when Republicans take back Congress, as they will at some point in time?
Just a thought.

If the American people are crazy enough to vote this current batch of Republicans into the majority in both the House and Senate, and have no Democratic President to lay down some vetoes, then the American people are going to have to live with the consequences.

Originally Posted by playwrite

First, responding to Firedoglake's Jane Hamsher's "10 Reasons to Kill the Bill,' he puts the number of people actually impacted by this in perspective -

Speaking of Jane Hamsher, I almost fell off my treadmill this morning when I saw her on Faux and Friends. WTF. Isn't it enough that we're having to fight off "death panels?" Seems like some on the Left aren't bothering to read the bill either.

Hmmm... I wonder why that Monday-morning spike keeps happening every time a new compromise is announced and the legislation crosses a major hurdle..

Originally Posted by Child of Socrates

If the American people are crazy enough to vote this current batch of Republicans into the majority in both the House and Senate, and have no Democratic President to lay down some vetoes, then the American people are going to have to live with the consequences.

If the American people are crazy enough to retain this current batch Democrats as the majority in both the House and Senate, and a Democratic president who lacks the will, the courage and the clout to be able to put his foot down, stand firm and deliver a veto, the American people are going to have to be willing and able to rise up and take on the consequences.

Originally Posted by independent

Hmmm... I wonder why that Monday-morning spike keeps happening every time a new compromise is announced and the legislation crosses a major hurdle..

Let's give this something that a lot of folks here lack - perspective

- by putting it first in the context of this chart -



- based on Nate Sliver analysis -
http://www.fivethirtyeight.com/2009/...of-health.html

As of 11 AM Eastern time, stocks for the six largest publicly-traded health insurance companies have risen by an average 4.49 percent, as weighted by their market capitalization. As the S&P 500 index had gained 1.09 percent as of 11 AM, these stocks have overperformed the market by 3.40 percent. Although some of the gain may reflect unrelated good news in the health sector, it is safe to assume that most of the improvement in prices reflects improved odds of the Senate's health care bill passing.
...

The 3.40 percent net gain translates into about $3.34 billion in market capitalization added. However, these six stocks do not represent the entirety of the private health insurance market. Collectively, they insure about 106 million people (WellPoint 35 million; United Health 26 million; Aetna 18 million; Humana 12 million; CIGNA 10 million; Coventry 5 million) as compared to a baseline of about 203 million private insurance policies nationwide, or about 52 percent of the total. Accounting for the gain in market value realized by the unaccounted-for private insurance companies would bring the total value added to $6.41 billion.

Additionally, the Senate's health care bill did not go from a 0 to 100 percent chance of passing overnight. Rather, with the news over the weekend that Ben Nelson would support the package, a more reasonable estimation is that it went from having roughly a 50 percent chance of passing to about a 90 percent chance -- an improvement of 40 percent. Thus, the run-up in stock prices today reflects about 40 percent of the overall gain in value to the private insurance companies from the Senate's bill passing. This would mean that the total value added from passage of the bill is $16.04 billion. [Nate is being very kind here. ]

That's a lot of money: $16 billion. But relative to the total outlay from the bill, it is fairly small. Over the course of the next ten years, the Senate's bill directs about $447 billion in public subsidies to people for the purchase of private health insurance. (This is in addition to another $400 billion or so in subsidies for the expansion of Medicaid). The $16 billion in value-added, therefore, represents about 3.6 percent of the subsidy. Coincidentally -- and it is mostly a coincidence, since the numbers are not directly comparable for a variety of reasons -- this compares rather neatly to the 3.3 percent profit margin in the health insurance industry overall.

Another way to look at this is that the Senate's bill will add about 17 million nonelderly members to the private insurance companies' enrollment relative to the baseline case, according to the CBO. As about 177 million nonelderly Americans currently have private insurance, this represents a 9.6 percent increase in their customer base.

Conversely, the stocks of these companies have improved by 3.4 percent today, relative to the market. But, as per our previous estimate, today's gain reflects only about 40 percent of the value to these companies of the Senate's bill passing; this implies that the total gain to these companies from passage of the bill (vis-à-vis the status quo) is 8.5 percent.

You should see that these two numbers -- 9.6 percent and 8.5 percent -- are broadly comparable. What this probably implies is that the increase in share prices today reflects an expectation of higher volumes -- but probably not higher profit margins, which are likely to remain fairly low in the industry.

Yet another neat coincidence is that the roughly $16 billion in value-added we estimate that the Senate's bill is worth to private insurers is in broadly the same ballpark as the $20-$25 billion that the weak public option was expected to save the government.

The bottom line is that, by the stock market's estimation, the private health care industry appears as though it will benefit if the Senate enacts its plan. But the benefit -- about $16 billion in discounted cashflows -- is small as compared to the total magnitude of the program, and likely reflects an increase in the size of their customer base rather than any anticipation of higher profit margins.

and further expanded on by Ezra -

http://voices.washingtonpost.com/ezr...predict_h.html

Running the numbers, Silver estimates that the market values reform at $16 billion or so for the insurance industry. It's a necessarily uncertain estimate, but Silver's assumptions are fairly generous, so if anything, it's probably a bit high. And although $16 billion is a lot of money, it's peanuts in terms of the total reform package. As Silver says, "Over the course of the next ten years, the Senate's bill directs about $447 billion in public subsidies to people for the purchase of private health insurance. (This is in addition to another $400 billion or so in subsidies for the expansion of Medicaid). The $16 billion in value-added, therefore, represents about 3.6 percent of the subsidy."

I want to make a slightly different point: Look at the graph atop this post. This bill is not, in the market's estimation, a gamechanger for the insurance industry. All of these stocks have seen both larger rises and larger falls in the past. None of them have recovered to their pre-crash highs. The market is not viewing the insurance industry in a dramatically different light than was true a year ago.

This is, at best, back-of-the-envelope work. But so too is divining the true worth of the health-care reform bill by tracking the daily fluctuations in the stock prices of insurers. The market is a confusing beast. Maybe it doesn't understand how awesome the health-care bill really is for the private insurance industry. Maybe it foresees a future in which insurers make more money for a period, and then government continues regulating insurance industry behavior and profits, and insurers are eventually driven out of business or into a new type of business that doesn't allow for much in the way of profits. Maybe it thinks the fallout too uncertain for big bets. It's all hard to say. And it makes this sort of thing a bad way to understand the health bills.

Some pay attention to actual game changers and cheer; others dwell on uncertain peanuts and bitch.

Check and mate.

Originally Posted by Child of Socrates

Speaking of Jane Hamsher, I almost fell off my treadmill this morning when I saw her on Faux and Friends. WTF. Isn't it enough that we're having to fight off "death panels?" Seems like some on the Left aren't bothering to read the bill either.

yea, it is disheartening. This am, someone showed me an article from yesterday's Wash. Examiner, the Capital's right wingnut trash paper, that used her list of 10 (without any attibution, by the way).

Unfortunately, I think the Netroots having been correct on Iraq and helping Obama become first the nominee and then President, have gotten way too full of themselves - they just can't be wrong or expected to be pragmatic, oh no!

Maybe a little humility with some experience at losing or at least not gettng their way will be helpful - part of the process of getting their heads-on-straight and getting really ready for Nov. 2010 - I hope.

Something akin to not being able to truly love until truly hurt.

We'll see.

Sorry, Playwrite, I cannot share your optimism. Just because you have health insurance doesn't mean you get actual health CARE if the deductibles and co-pays and what-not are ridiculous.

Never trust a for-profit entity to do the right thing, because all they care about is maximizing profits for their shareholders. The whole damn health insurance industry can't be reformed anymore than a Mafia extortion racket can be reformed.

Originally Posted by Odin

Sorry, Playwrite, I cannot share your optimism. Just because you have health insurance doesn't mean you get actual health CARE if the deductibles and co-pays and what-not are ridiculous.

Never trust a for-profit entity to do the right thing, because all they care about is maximizing profits for their shareholders. The whole damn health insurance industry can't be reformed anymore than a Mafia extortion racket can be reformed.

It's not single payer. It doesn't have a public option.

What it has is more subsidies to more people than any Liberal could have imagined just a little more than a year ago. It has more regulation and safeguards against insurers than ever before. It is closer to becoming reality as a major progressive piece of domestic legislation than any thing else in the last 40 years.

That's not optimism, those be facts.

Let's lock this in place, and then keep hammering away for more.

Once passed, Sen. Harkin will introduced a public option amendment. That can go the recission route (51 votes, not 60); it cannot be Byrd Dropped. It will depend on the 2010 election more than anything else. The Dems get hammered, then it will go away until people re-learn the lessons on 2000-2008 - that may be a long time.

Progressives need to quit whinning and start manning the phones and internet with support. At last, I don't think they'll wake up to it until this bill goes through and Harkin proposes his bill. Hope it won't be too late.

If you need motivation, think Michelle Bachman and Mike Enzi as majority chairs of the committees that deal with health care - you think you're going to be better off?

Originally Posted by Odin

Never trust a for-profit entity to do the right thing, because all they care about is maximizing profits for their shareholders. The whole damn health insurance industry can't be reformed anymore than a Mafia extortion racket can be reformed.

Language is tricky. This bill is not about "reforming" the health insurance industry in the same sense as rehab is about "reforming" a drunk. Instead, it's about "reforming" the industry in the same sense as a company is "reformed" when it comes under new management. The difference being that we don't seek changes of character, but only changes of behavior, and that through a rewriting of the legal rules and ongoing supervision.

I would prefer to see a public option because I would prefer to see a single-payer system and I believe (as I think Obama believes, and obviously as the health insurance industry believes, too) that a public option would become a single-payer system over time. I'm disappointed that the Senate bill doesn't include one for that reason. BUT, regarding immediate results, let's be clear on something: the public option would do very little right away. In terms of short-term outcome, its loss is not much of a loss, given the new regulations that the bill contains.

This bill is acceptable to the insurance industry, and it's a natural reflex to suppose that means it will make things worse, but that's not necessarily so. Insurance companies by the nature of the industry (and I say that as someone who works in the industry, although not in health insurance) are used to thinking in the long term and about large-scale aggregate results. There's a kind of enlightenment built into the sort of thinking necessary to succeed at it. That the U.S. health-insurance system is broken is obvious to anyone who knows anything about it, and so it's a safe bet that the insurance companies are aware of the situation. Continued spiraling of costs out of control, continuing shrinkage of people who can be covered -- these are not good things for the profitability of health insurance. Like any commercial industry, it depends on keeping its customers happy and happily paying.

So a continued trajectory as things were going was not acceptable to the industry, I'm sure, but on the other hand there was a risk of reforms that would kill the industry completely, such as adoption of a single-payer system. So a reform that makes things markedly better for insurance consumers, without killing the industry, is from their point of view ideal.

Personally, I'd like to see a single payer system and the death of the health insurance industry -- rest in peace. But just because the proposed reforms would not kill the industry doesn't mean they won't make things better. The industry knows reform is needed. That's why they find the Senate bill acceptable, because it's reform that will work, without killing them.

Originally Posted by playwrite

Originally Posted by Ezra Klein

In return for that, [i.e., the 2% penalty] you get guaranteed treatment at hospitals and an insurance system that allows you to purchase full coverage the moment you decide you actually need it. In the current system, if you don't buy insurance, and then find you need it, you'll likely never be able to buy insurance again. There's a very good case to be made, in fact, that paying the 2 percent penalty is the best deal in the bill.

Read that bolded, underlined sentence until you finally GET IT - particularly my Xer pragmatic friends!

Well the first part of the bolded section is already true. You can always get treatment. However, you may go deeply into debt doing so. The latter part is nice, but being able to purchase something and being able to afford it are not the same thing. Sure, the insurance companies can't deny you coverage, but they're going to charge through the nose if your pre-existing condition is expensive. There's nothing in the bill that prevents that, as far as I know.

For the average family affected by this, the 2% tax penalty will wipe out their usual tax refund in its entirety. This may be cheaper than health insurance, but it is more than they're paying now.

Originally Posted by playwrite

For 2%, YOU ARE GUARANTEED TO BE ABLE TO GET INSURANCE COVERAGE OF ANY ILLNESS OR ACCIDENT SHOULD YOU DECIDE THAT YOU NEED IT.

Given that coverage denial is notable but uncommon this isn't as big a deal as you make it out to be. Most of the uninsured are only temporarily so and become insured upon getting a better job. For the vast majority of people affected, their taxes go up and they get absolutely nothing they didn't have before.

Also Klein neatly dodges the primary criticism of this bill -- that it is written as if the problem with health care in America is that lazy poor people and apathetic youths aren't buying insurance. When an industry is widely regarded as full of abuse, I know that the first reform I always think of is to force people to buy their product. </sarcasm>

Originally Posted by playwrite

Let's lock this in place, and then keep hammering away for more.

LOL. Or maybe after the blue team scores, it will just be content to run out the clock. After all, they've got your vote locked up. Why would there be any priority on health care reform? You would have just received some health care reform. "Give the current legislation time to work," they'll say. And when a bunch poor people get screwed out of a tax return in April 2011, they're going to be just giddy at the prospect of another "reform" coming out of the sausage factory.

I hear they're going to "reform" Wall Street next. Pro tip: buy financial stocks.

Originally Posted by playwrite

It's not single payer. It doesn't have a public option.

But it does allow for state based public options through the Cantwell amendment.

Originally Posted by PW

What it has is more subsidies to more people than any Liberal could have imagined just a little more than a year ago. It has more regulation and safeguards against insurers than ever before. It is closer to becoming reality as a major progressive piece of domestic legislation than any thing else in the last 40 years.

That's not optimism, those be facts.

Let's lock this in place, and then keep hammering away for more.

Once passed, Sen. Harkin will introduced a public option amendment. That can go the recission route (51 votes, not 60); it cannot be Byrd Dropped. It will depend on the 2010 election more than anything else. The Dems get hammered, then it will go away until people re-learn the lessons on 2000-2008 - that may be a long time.

IMHO, that's why this bill, despite its flaws, needs to get wrapped up ASAP and get on to student debt relief. More on this below.

Originally Posted by PW

Progressives need to quit whinning and start manning the phones and internet with support. At last, I don't think they'll wake up to it until this bill goes through and Harkin proposes his bill. Hope it won't be too late.

If you need motivation, think Michelle Bachman and Mike Enzi as majority chairs of the committees that deal with health care - you think you're going to be better off?

As I've watched the whole teabag movement take with mostly people of a certain age and up, I'm beginning to suspect that the social moment transition from one dominant generation to another may well be a force with even more power than even S and H suspected.
This is the first social moment to occur after the theory has become generally known to a critical mass of influential individuals who have the power in their various positions to use such knowledge in a way as they see to their advantage.
To give an example of this which is slightly off topic, I will be surprised if the US is able to pass a major climate change bill anytime soon. I see things this way because from what I see most boomers seem to have effectively punted this issue off into the future so that they don't personally have to deal with it. And of course big oil and related concerns no doubt have advisers and consultants who are familiar with this theory and have tailored their demographic appeals towards maximizing the desire by aging boomers to not deal with an issue that is mostly going to have consequences after their time.
To get back on topic, the short term benefactors of this healthcare bill will be late wave boomers and Xers. The millies are still young enough to not be too concerned with serious personal health issues. And the young and healthy are Obama's base-they need something to fight for before the 2010 midterms approach.
Student debt relief would be an issue that would resonate with the millies. The ability for a young person to be able to persue their dreams at the college level without facing a lifetime of bondage to rent seekers would do a lot to restore the American dream as it existed before the culture wars sent America on a quarter century long quest for its inner child.
But the healthcare bill has to be wrapped up first.
Then we can spend time focusing solidly on debt relief.

Originally Posted by herbal tee

But it does allow for state based public options through the Cantwell amendment.
IMHO, that's why this bill, despite its flaws, needs to get wrapped up ASAP and get on to student debt relief.

Are you thinking student debt relief because it will cause the Millies to wake up?

As I've watched the whole teabag movement take with mostly people of a certain age and up, I'm beginning to suspect that the social moment transition from one dominant generation to another may well be a force with even more power than even S and H suspected.

Unfortunately, it's the middle aged and elderly who are making up their vocal opposition as well..
Also one cannot get Millies to rebel against their parents openly, not in the same, direct, often violent way that the Boomers did. We MUCH prefer reconcilliation. Case in point, if you look at all my earlier posts on this forum from around the summer and when the tea parties first started happening, I was saying that Dems were being too combative and were only opposing the tea baggers because they disagreed with them poltically. I don't think I really started getting angry at the Republicans themselves until much later. I think most of us are still in that earlier stage.

To give an example of this which is slightly off topic, I will be surprised if the US is able to pass a major climate change bill anytime soon.

(facepalm) Oh God no. Anything having to do with Global Warming in this current environment would be worse than impossible. All environmental bills must, imo, be framed as "reducing foreign oil" for any hope of passage.

Originally Posted by writerGrrl

Are you thinking student debt relief because it will cause the Millies to wake up?

"Wake up" is a good way to put it. One of the good things about progressiveism is that all of the ideas are both politically smart and good for the country.
I graduated from college in 1983 without any student debt-barely.
If I had needed another year to finish my BA, the debt mill would have processed and exploited me. Almost all of my friends who are younger than me have suffered a lower standard of living because they have been forced to pay tribute to usurers.
Many of them have also been forced to curtail their plans because 3T America has been about pretending that the future would be hunky dorey without investing in education, infastructure or other future related assets and everyone would get rich quick as long as the already rich got theirs.
Reagan was the greatest snake oil salesman in history.

Originally Posted by WG

Unfortunately, it's the middle aged and elderly who are making up their vocal opposition as well..
Also one cannot get Millies to rebel against their parents openly, not in the same, direct, often violent way that the Boomers did. We MUCH prefer reconcilliation. Case in point, if you look at all my earlier posts on this forum from around the summer and when the tea parties first started happening, I was saying that Dems were being too combative and were only opposing the tea baggers because they disagreed with them poltically. I don't think I really started getting angry at the Republicans themselves until much later. I think most of us are still in that earlier stage.

This next year is going to matter. Right now, a lot of the corporate media is salivating over the prospect of elder anger fueling a Republican resurgance. If the economy picks up as the spring thaw allows many of the stimulus projects that have been approved to be constructed, which may well happen, the Republicans are going to lose the economy as an issue and be left with only anger over, well, who knows what kind of faux rage the corporate media may try to sell in 2010.
None of that has to matter. The millies don't even have to get mad at those who would sacrifice their future in the service of discredited establishment interests, they just have to get even with them on election day. :

Originally Posted by WG

All environmental bills must, imo, be framed as "reducing foreign oil" for any hope of passage.

That's a start. Also, the idea of rebuilding our industrial base around clean energy would hold a lot of appeal to people. The stimulus bill shows some movement in that direction.

Originally Posted by Kurt Horner

Well the first part of the bolded section is already true. You can always get treatment. However, you may go deeply into debt doing so.

And that, in the real world, often equates to not getting health care particularly for kids, I've posted more than once the studies reporting significant increases in morbidity among people, particularly kids, that lack insurance - thousands die.

Originally Posted by Kurt Horner

The latter part is nice, but being able to purchase something and being able to afford it are not the same thing. Sure, the insurance companies can't deny you coverage, but they're going to charge through the nose if your pre-existing condition is expensive. There's nothing in the bill that prevents that, as far as I know.

Au contraire, no bias against pre-condition or gender, the former due to the required use of "community rating"; the latter due to its specific forbidding.

Originally Posted by Kurt Horner

For the average family affected by this, the 2% tax penalty will wipe out their usual tax refund in its entirety. This may be cheaper than health insurance, but it is more than they're paying now.

Subsidies are provided up to 400% income level - that would be around $60K for individual and $80K for family of 4. Average income for US family is around $52K; individual much less. Under the 400% incomes, I think the subsidies, for most below these income levels, exceed the 2% and for the rest make the costs of guaranteed coverage even less significant. An individual making over $60K, but particularly a guy with a wife and two kids (do you know how much an uninsured pregnancy costs?!) would be a complete idiot not to have health insurance let alone looking at the 2%-priced insurance guarantee as anything but a great deal.

Originally Posted by Kurt Horner

Given that coverage denial is notable but uncommon this isn't as big a deal as you make it out to be. Most of the uninsured are only temporarily so and become insured upon getting a better job.

I don't have the numbers in front of me but I'm certain they are in the 100s not just 10s of thousands. Sure, that pales against the 30 million that go uninsured, but tell that to someone who has a really sick spouse or kid and have to decide between seeking medical help or eating. I really hope you never have to experience that choice to grow a little empathy.

Originally Posted by Kurt Horner

For the vast majority of people affected, their taxes go up and they get absolutely nothing they didn't have before.

Wrong on both fronts. The bills were very specifically crafted not to raise general revenue income taxes on most people. The money is primarily coming from either taxes on Cadillac insurance benefits (that have been provided in lieu of wages due to income tax benefits) or those making over $250K and also in reductions to overpayments under Medicare Part D.

Your latter statement comes from the fact that most people are covered by employer-based insurance. There are some benefits for these folks coming (e.g., being able to cover their kids until age 26) but what you are most overlooking is that thousands are dumped from these plans each year due to either losing their jobs or their employers, particularly small businesses, dropping the benefit. Most experts believe that under the current system, employer-based insurance is doomed - businesses won't be able to afford something that grows at 3-4 times the rate of inflation.

Originally Posted by Kurt Horner

Also Klein neatly dodges the primary criticism of this bill -- that it is written as if the problem with health care in America is that lazy poor people and apathetic youths aren't buying insurance. When an industry is widely regarded as full of abuse, I know that the first reform I always think of is to force people to buy their product. </sarcasm>

No country with universal health care, regardless of model, gets there without full participation in its costs -whether by premiums or taxes - it really comes down to simple math. I see the privilege of health insurance in our supposed great country as being no more or less that having an interstate highway system.

Originally Posted by Kurt Horner

LOL. Or maybe after the blue team scores, it will just be content to run out the clock. After all, they've got your vote locked up. Why would there be any priority on health care reform? You would have just received some health care reform. "Give the current legislation time to work," they'll say. And when a bunch poor people get screwed out of a tax return in April 2011, they're going to be just giddy at the prospect of another "reform" coming out of the sausage factory.

I hear they're going to "reform" Wall Street next. Pro tip: buy financial stocks.

Given what you don't know and assume about this bill (by the way, pretty surprising coming from you), I can understand your pessimism. I'm sure you're going to feel a whole hell of a lot better once you let Michelle Bachman and Mike Enzi become the chairs of the committees that deal with our health care laws.

Originally Posted by herbal tee

As I've watched the whole teabag movement take with mostly people of a certain age and up, I'm beginning to suspect that the social moment transition from one dominant generation to another may well be a force with even more power than even S and H suspected.
This is the first social moment to occur after the theory has become generally known to a critical mass of influential individuals who have the power in their various positions to use such knowledge in a way as they see to their advantage.
To give an example of this which is slightly off topic, I will be surprised if the US is able to pass a major climate change bill anytime soon. I see things this way because from what I see most boomers seem to have effectively punted this issue off into the future so that they don't personally have to deal with it. And of course big oil and related concerns no doubt have advisers and consultants who are familiar with this theory and have tailored their demographic appeals towards maximizing the desire by aging boomers to not deal with an issue that is mostly going to have consequences after their time.
To get back on topic, the short term benefactors of this healthcare bill will be late wave boomers and Xers. The millies are still young enough to not be too concerned with serious personal health issues. And the young and healthy are Obama's base-they need something to fight for before the 2010 midterms approach.
Student debt relief would be an issue that would resonate with the millies. The ability for a young person to be able to persue their dreams at the college level without facing a lifetime of bondage to rent seekers would do a lot to restore the American dream as it existed before the culture wars sent America on a quarter century long quest for its inner child.
But the healthcare bill has to be wrapped up first.
Then we can spend time focusing solidly on debt relief.

A lot to agree on here.

I think Xers have the key role in at least the transition.

One element of Obama as more an Xer than Boomer is how his pragmatism is being taken to task by both sides - teabggers, mostly made up of Right wingnut Boomers and Netroots mostly made up of Millies from the passionate Left.

I remember people trying to sell Bush's decisions from the standpoint that not only does he have the bigger picture due to more information but to being surrounded by a host of experts. As a Boomer, myself, I could certainly see that may still result in pretty stupid decisions given his fundamental ideology - and history proves that to be the case.

On the other hand, I'm more willing to give the benefit-of-the-doubt to a well-informed pragmatic Xer - as long as they see themselves as a change agent for society and behave as such, rather than the typical Xer nihlists so often displayed on this forum.

I think Obama is that guy.

Some good exchanges there, WT and HT.

Can't agree more.

What is a "Gilbertarian"?

Originally Posted by playwrite

Au contraire, no bias against pre-condition or gender, the former due to the required use of "community rating"; the latter due to its specific forbidding.

Yes, except the "wellness program" clauses appear to simply switch us from a system where high-risk people are charged more to a system where low risk people are charged less. Not that price discrimination is particularly a bad thing . . . the entire practice of insurance is based on gauging and pricing risk. So, the way we're fixing the fact that we've forced all health care purchasing into an insurance system is to make health insurance not really like insurance at all.

Originally Posted by playwrite

An individual making over $60K, but particularly a guy with a wife and two kids (do you know how much an uninsured pregnancy costs?!) would be a complete idiot not to have health insurance let alone looking at the 2%-priced insurance guarantee as anything but a great deal.

That individual would, IMO, be foolish not to have health insurance now. Sure, the subsidies might be enough that it's cheaper to buy the coverage than take the tax penalty or that the difference is enough to make the insurance the better deal. But that is a subjective assessment by each person. The subsidies still don't cover the full cost, so regardless of whether the person gets coverage or not, this legislation imposes costs on them that they previously did not have to bear. You can say it's a "good deal" but in so doing you are imposing your perception of the value of insurance upon them.

Originally Posted by playwrite

I don't have the numbers in front of me but I'm certain they are in the 100s not just 10s of thousands.

I'm under the impression that outright denial of coverage is rare. More typical is the denial of specific claims. Are there people who cannot get coverage, or where coverage is extremely expensive? Yes, and one cause of that is a significant lack of competition in the insurance market. One good thing about this bill is that the Exchanges might lead to a more competitive market. I suspect that this won't work out though, since there won't be a nationwide system unless federal officials push for it and no states object. It is more likely that the present system with all sorts of arcane boundaries between interstate competition will persist.

A serious reform would simply invoke the interstate commerce clause and declare all state laws restricting the sale of insurance across state lines to be immediately invalid, regardless of group size. But simple, sweeping reforms have the virtue of causing real change which is obviously not the goal.

Originally Posted by playwrite

Wrong on both fronts. The bills were very specifically crafted not to raise general revenue income taxes on most people.

I said taxes in general. Who cares which part of a person's tax burden is affected? It's the same money to them. The penalty for not buying insurance is assessed on everyone regardless of income level. I wasn't critiquing how the subsidies get paid for, I was critiquing the direct costs imposed on those who presently do not have insurance.

Originally Posted by playwrite

Most experts believe that under the current system, employer-based insurance is doomed - businesses won't be able to afford something that grows at 3-4 times the rate of inflation.

Indeed, but I'm not really clear on how precisely individuals will be able to afford something their employers cannot. Are there some provisions in this bill that will reasonably slow the growth of medical costs?

Originally Posted by playwrite

Given what you don't know and assume about this bill (by the way, pretty surprising coming from you), I can understand your pessimism.

In replying to your post, I did go and look at the bill text, specifically the ban on discrimination since I wanted to make sure I was clear on how it works. It did help to understand specifically how the new system is intended to work. However, it is important that some of the arguments you're using to defend this bill are not simply factual matters. On the matter of the tax penalty for failing to buy insurance, you're allowing a subjective assessment of whether it's a "good deal" to color the simple fact that some of the very people for whom this reform is intended are going to be forced into new additional expenses. Now you can argue that this penalty is small and not a big deal, but it is there.

To me, the payment problem is simply the result of overemphasizing insurance. The co-op idea briefly floated by the Blue Dogs was a rare good idea in Congress. Alas, those too were going to be restricted to the small group market. The quick death of that idea demonstrated that outside-the-box ideas were not welcome.

Originally Posted by playwrite

I'm sure you're going to feel a whole hell of a lot better once you let Michelle Bachman and Mike Enzi become the chairs of the committees that deal with our health care laws.

I hear you -- the fact that the GOP hasn't pushed for interstate competition in insurance is yet another demonstration that their advocacy of markets isn't consistent or principled.

On a basic philosophical point: Kurt, you seem in several places to be advocating a market-based solution to our health-insurance woes. There is a fundamental problem with this as I see it.

The advantage of a market is that it is, within its own parameters, self-regulating and there is no need to micromanage it; also, strictly in terms of allocating resources to meet demand (demand being economically defined as desire + ability to buy), it is the most efficient approach to a chaotic stimulus. The disadvantage is that it is ruthless and uncaring, does not address people's needs unless they have the ability to pay for them, and always leaves a certain percentage of the population out of play. Also, a market's price-regulating feature depends on the ability of consumers to walk away from a sale.

Usually, this means that a market-based system is not going to be ideal when applied to necessities. Now sometimes a necessity can be so abundant that a market comes very close to working, but even when that's the case some effort is needed to help the poorest people to get by. (Food is a good example there, and also transportation.) But this is so only because we are able to produce these necessities in cheap abundance. In the ancient world, it was necessary to remove basic foodstuffs from pure market control as well.

Some portions of the health-care problem could benefit from a market approach. For example, an unacceptable portion of the cost of pharmaceuticals is pure profit. Introducing more competition would force those prices down. But with respect to other parts, and health insurance is definitely included here, that simply won't work. No matter how you cut it, the health insurance industry has to take in enough in premium to pay out claims made. Insurance is a way of socializing risks. The bigger the pool of pay-ins, the cheaper coverage can be. And so requiring everyone to buy into the system (while subsidizing those who can't afford to) will automatically allow prices to be held down, and there are enough regulations in this bill that they will be held down -- in other words, the extra premium won't go to pure profit.

It's easy to see that mandate as a pay-off to the insurance industry, but it's absolutely necessary. As I said above, the insurance industry knows very well that reform is necessary or they're going to end up killing the goose that lays their golden eggs, so just because they approve of it doesn't mean automatically that it's a bad deal for the rest of us. Our relationship with the insurance industry isn't quite a zero-sum, win-lose situation. Reform could benefit us while also benefiting them, at least in the long term, and I'm sure they're thinking long-term. That is, it could end up better for them down the road, than what the current system will become down the road, because it helps us, too.

The more I look at what the Senate has done, the better I like it. I would like it better if it included a public option, and if it did something about the problem of pharmaceutical prices. But it's quite a good start. The use of private insurance carriers within a public system has some history; it's part of the medical systems of Germany, Japan, and France, all of which are rated quite highly. What it's missing can be added later, and the fact that this bill can pass will set a precedent making it easier to add those things later.

Originally Posted by Brian Rush

Language is tricky. This bill is not about "reforming" the health insurance industry in the same sense as rehab is about "reforming" a drunk. Instead, it's about "reforming" the industry in the same sense as a company is "reformed" when it comes under new management. The difference being that we don't seek changes of character, but only changes of behavior, and that through a rewriting of the legal rules and ongoing supervision.

I would prefer to see a public option because I would prefer to see a single-payer system and I believe (as I think Obama believes, and obviously as the health insurance industry believes, too) that a public option would become a single-payer system over time. I'm disappointed that the Senate bill doesn't include one for that reason. BUT, regarding immediate results, let's be clear on something: the public option would do very little right away. In terms of short-term outcome, its loss is not much of a loss, given the new regulations that the bill contains.

This bill is acceptable to the insurance industry, and it's a natural reflex to suppose that means it will make things worse, but that's not necessarily so. Insurance companies by the nature of the industry (and I say that as someone who works in the industry, although not in health insurance) are used to thinking in the long term and about large-scale aggregate results. There's a kind of enlightenment built into the sort of thinking necessary to succeed at it. That the U.S. health-insurance system is broken is obvious to anyone who knows anything about it, and so it's a safe bet that the insurance companies are aware of the situation. Continued spiraling of costs out of control, continuing shrinkage of people who can be covered -- these are not good things for the profitability of health insurance. Like any commercial industry, it depends on keeping its customers happy and happily paying.

So a continued trajectory as things were going was not acceptable to the industry, I'm sure, but on the other hand there was a risk of reforms that would kill the industry completely, such as adoption of a single-payer system. So a reform that makes things markedly better for insurance consumers, without killing the industry, is from their point of view ideal.

Personally, I'd like to see a single payer system and the death of the health insurance industry -- rest in peace. But just because the proposed reforms would not kill the industry doesn't mean they won't make things better. The industry knows reform is needed. That's why they find the Senate bill acceptable, because it's reform that will work, without killing them.

Brian, I believe you've just made a case for why a single-payer system may NOT be the best way to go. Would a completely-government-owned-and-run system have the same potential level of enlightened self-interest as the private health-insurance industry has with regard to long-term profitability? Perhaps not. On the other hand, the industry had lost its way, and if it took the spectre of their own demise to get them back on track, I'd agree that's a good thing, both for them and for the Nation.

I would love a single-payer system, but I am first and foremost a pragmatic sort of gal, so I will take this bill as a start toward something better in the future.

And if some of the Lefties want to start aligning with scum like Grover Norquist, they're just as crazy as the teabaggers. Nothing like starting up that old circular firing squad.

Krugman takes a victory lap. For discussion purposes...

Originally Posted by NY Times

Indulge me while I tell you a story — a near-future version of Charles Dickens’s “A Christmas Carol.” It begins with sad news: young Timothy Cratchit, a k a Tiny Tim, is sick. And his treatment will cost far more than his parents can pay out of pocket...

Again, the interesting point is he repeated again a need to reform the Senate filibuster rules. I'm wondering if we will see this repeatedly in his pieces, along the lines of Cato the Elder's "Carthage must be destroyed..."