Usual disclaimers apply.



During the social moment year of 1935 the Social Security Act was passed.
During the social moment year of 1965 the Medicare Act was passed.
In both cases, the life of the average American was improved.
It is a social moment year again.
It is time again.

But what is the impact on childless married couples at various income levels - or, for that matter, single individuals?

Inquiring minds want to know - or is that somehow classified information?

Originally Posted by Kurt Horner

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.

No, it is a switch from individual risk to community (or, social) risk. But yes, that does make the insurers become essentially heavily-regulated middlemen in the paper shuffle. One might argue that because they are private, they will automatically be more efficient at it than publc administation. 'Unfortunately,' Medicare proves that notion only to be a worn-out 3T Ray-gun meme. Once this sucker is in place, it will only be a matter of time before that dawns on everyone (on an individual level, even the "Hands off my Medicare" teabaggers will get it). Watch the insurers diversifying out of the business as the early (if not, the ultimate) indicator of the change that will occur.

Originally Posted by Kurt Horner

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 Kurt Horner

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 Kurt Horner

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.

Kurt, I've already laid out how few people are effected by this (e.g, has nothing to do with 85% of the people on employer or govt insurance/programs, exemptions for low income, kids up to 26 stay on parents plans, subsidies for people even above average incomes, etc) or how little cost, relative to value, this provides even to those who wind up paying the 2% penalty (guarranteed insurance coverage when you want it) so I'm not going to rehash it.

What you want me to do is provide a modicum of respect to a Glibertarian viewpoint that we are forcing people against their wills to do something. I'm not likely to do that under normal circumstances. But, what we have here is a historic moment of major forward movement in the Progressvie agenda that is going to get health care coverage to millions. So, I hope you can understand, I don't see the Glibertarian viewpoint as deserving even a modicum of respect, I see it as something to piss on.

Originally Posted by Kurt Horner

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.

Another idea worthy of piss. I don't want a race to the bottom by states as to which can offer the least bit of regulation to entice the insurers to gravitate to them. Delaware is already doing fine with the credit card companys that currently get money at 1% or less and then turn around and lend it to people on revolving credit from 9-19% that with late fees and other tricks can make the real APR jump to 50-75%.

I understand that the Mariana Islands (a US Territory) is standing ready to offer the insurers a post office box without any regulations - gee, I wonder what provider network the Mariana insures will be offering in NYC.

Originally Posted by Kurt Horner

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?

Lots, and it is just the start.

Originally Posted by playwrite

One might argue that because they are private, they will automatically be more efficient at it than publc administation. 'Unfortunately,' Medicare proves that notion only to be a worn-out 3T Ray-gun meme. Once this sucker is in place, it will only be a matter of time before that dawns on everyone (on an individual level, even the "Hands off my Medicare" teabaggers will get it).

'Unfortunately' it is the corporate Dem apologists who are currently resuscitating this meme, and its their supporters who are marketing it. Its pretty obvious that competition is a different thing than distributing, pooling, or otherwise socializing risk, but its the 'loyal' Dems who are refusing to acknowledge such.

Originally Posted by playwrite

What you want me to do is provide a modicum of respect to a Glibertarian viewpoint that we are forcing people against their wills to do something. I'm not likely to do that under normal circumstances. But, what we have here is a historic moment of major forward movement in the Progressvie agenda that is going to get health care coverage to millions. So, I hope you can understand, I don't see the Glibertarian viewpoint as deserving even a modicum of respect, I see it as something to piss on.

And likewise, you want us to applaud a mostly regressive funding for a paper-pushing middle-man. Not only will this bill increase the customer base for a failed industry, it will also lock in 3T-levels of waste - levels of administrative spending and profit that didn't even exist in the last 2T.

Definitely an idea worthy of piss. But yeah, I'm sure the voters will love paying extra corporate taxes for a few years before they get any extra coverage

The best argument your side has is that this bill will make people want more. Its kind of funny because the ones supporting this bill are also the ones resisting any more significant changes and keeping low standards for what it should accomplish.

When this terrible legislation causes Dems to lose more seats to progressives and independents and even Republicans (in Blue-dog districts) how will they pass a 'better bill' in the future?

Originally Posted by independent

Not only will this bill increase the customer base for a failed industry, it will also lock in 3T-levels of waste - levels of administrative spending and profit that didn't even exist in the last 2T.

Not so. Please study the bill. It will substantially reduce administrative spending, counting both private and government spending.

The best argument your side has is that this bill will make people want more.

No, the best argument is that it will create a situation vastly improved over what we have now. People already want more, and the bill would have more but for Senate procedural rules. But any health-care reform that will work at all (and this proposal will) is going to accustom the uneasy to the idea of government oversight of health insurance, and that will reduce opposition to further reform.

Its kind of funny because the ones supporting this bill are also the ones resisting any more significant changes and keeping low standards for what it should accomplish.

Not true. For example, I support it -- in the sense that I would rather see it pass than fail. The insurance industry supports it -- in the sense that they know something has to be done, and this is gentler to them than a lot of alternatives. As I said elsewhere, we need to resist demonizing: just because the insurance industry is for this doesn't mean it's a bad deal for the rest of us. (It does mean it isn't as radically good a deal as a single-payer system, though.)

When this terrible legislation causes Dems to lose more seats to progressives and independents and even Republicans (in Blue-dog districts) how will they pass a 'better bill' in the future?

A seat lost by a Democrat to a more progressive Democrat will help further reform.

A seat lost by a Democrat to a more progressive independent will help further reform.

A seat lost by a conservative Democrat to a Republican will do diddly-squat in either direction, since either of those would be an opponent to further reform.

Not a problem, really.

Originally Posted by independent

'Unfortunately' it is the corporate Dem apologists who are currently resuscitating this meme, and its their supporters who are marketing it. Its pretty obvious that competition is a different thing than distributing, pooling, or otherwise socializing risk, but its the 'loyal' Dems who are refusing to acknowledge such.

I think if you could put your Glibertarian-colored glasses down for a second, you might come to the conclusion that it is better for us to have them competing over the costs of paperwork than over actual health care. If you can't figure that out, you either still have the glasses on or you're just stupid. Given the glimpses you've occasionally provided when the glasses are off, I don't think its the latter.

Originally Posted by independent

And likewise, you want us to applaud a mostly regressive funding for a paper-pushing middle-man. Not only will this bill increase the customer base for a failed industry, it will also lock in 3T-levels of waste - levels of administrative spending and profit that didn't even exist in the last 2T.

As compared to what, Indy? To the real world as it exist today? Or, to some utopian bullshit that allows you some sort of high ground for intellectual masturbation while thousands, including kids, die from lack of insurance? I don’t really want to be so tough on you, but really, either get over it or show us how you would get something better in the context of the reality we currently live in today.

Originally Posted by independent

Definitely an idea worthy of piss. But yeah, I'm sure the voters will love paying extra corporate taxes for a few years before they get any extra coverage

The best argument your side has is that this bill will make people want more. Its kind of funny because the ones supporting this bill are also the ones resisting any more significant changes and keeping low standards for what it should accomplish.

When this terrible legislation causes Dems to lose more seats to progressives and independents and even Republicans (in Blue-dog districts) how will they pass a 'better bill' in the future?

We'll see.

Originally Posted by playwrite

I think if you could put your Glibertarian-colored glasses down for a second, you might come to the conclusion that it is better for us to have them competing over the costs of paperwork than over actual health care. If you can't figure that out, you either still have the glasses on or you're just stupid. Given the glimpses you've occasionally provided when the glasses are off, I don't think its the latter.

Oh screw off with that anti-libertarian shit. What are you, some neo-con on 9/12? Its absolutely amazing that the 'opposite' parties have to spend so much time demonizing this common enemy of freedom-lovers. Just drop the name-calling, insults, and ridiculous partisan stereotypes if you want to be taken seriously.

As compared to what, Indy? To the real world as it exist today? Or, to some utopian bullshit that allows you some sort of high ground for intellectual masturbation while thousands, including kids, die from lack of insurance? I don’t really want to be so tough on you, but really, either get over it or show us how you would get something better in the context of the reality we currently live in today.

Well, we could set international success as our standard:



We could use pre-1980 levels of administration rather than locking it in at mid-90s rates of waste:




But I guess in your world, the "real world," we're only allowed to ask for a few extra inches of slack on the leash. Don't rock the boat or we might not get any crumbs! What a joke.

Originally Posted by The Rani

That last graph says it all. I was thinking the other day that any time a non-clinician with a financial motive is making decisions about health care, both physicians and patients are screwed.

I wunder what the government chart looks like? Let me guess, it would look like there's to many chiefs and not enough indians.

Pretty similar, except with waaaaaaaaay more growth under Reagan & Bush

Originally Posted by independent

Oh screw off with that anti-libertarian shit. What are you, some neo-con on 9/12? Its absolutely amazing that the 'opposite' parties have to spend so much time demonizing this common enemy of freedom-lovers. Just drop the name-calling, insults, and ridiculous partisan stereotypes if you want to be taken seriously.

Well, we could set international success as our standard:



We could use pre-1980 levels of administration rather than locking it in at mid-90s rates of waste:




But I guess in your world, the "real world," we're only allowed to ask for a few extra inches of slack on the leash. Don't rock the boat or we might not get any crumbs! What a joke.

Well, no shit Sherlock.

But now, just how do you proposed to accomplish reducing those costs? By pissing on Joe Lieberman's head? Ben Nelson's? The 40 Republican senators? In the real world, Indy, nobody is going to let you (or, your weinerschnitzel) get any where near them.

I'll go with the adults in the room and get a Progressive foundation in place; I don't have time for Gliberian fantasies. As I've challenged you repeatedly, propose something viable in our current political context, and maybe people will take you seriously.

Here's where the real fight is going, with decision date Nov 2, 2010 -

http://jed-lewison.dailykos.com/

Tea partiers: GOP should demand full repeal of health reform
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Pitted against a GOP pledge to seek full repeal of health care reform, a Democratic message focused on strengthening and improving it is likely to be received quite well by voters. To deliver that message with credibility, however, Democrats must concede that health care reform will be an ongoing process. This bill creates a framework, but there are still finishing touches to be done and important additions (like the public option) to be made. Just as importantly, Democrats must deliver, developing -- and committing themselves to -- new proposals to improve reform.

As Paul Krugman has noted, the Massachusetts experience shows that most people favor the "mend it, don't end it" approach. 59% of residents there support the state's reform law and even more -- 79% -- want it to continue. Only 11% favored repeal.

Those numbers don't mean people in Massachusetts are fully satisfied with health care reform, however. 43% say the state cannot afford the law unless it changes (just 40% say the state can afford it).

The bottom-line is that people in Massachusetts are not satisfied with the status quo, but they don't want to go back in time. For them, the biggest issue is cost control and affordability, and the same experience is likely to be repeated in the nation at large.

Once reform passes, Republicans will find themselves looking backwards, arguing for repealing the new health care reform law. That isn't a good position to be in. On the Democratic side, passing the law and declaring it the ultimate and final step in health care from would be equally untenable. But if Democrats credibly make the case that they not only have passed health care reform -- extending coverage to 94% of residents and protecting Americans from insurance company abuses -- but also have plans to improve it and make it even better, they very well may end up proving the political consensus -- that health care reform is a political disaster -- upside down.
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Given the current demographics, Xers will be swing votes. If you guys stay in your various Nihilists and Glibertarian roles you've honed so well, you're going to have to deal with the consequences of Michelle Bachmann and Mike Enzi as your go-to-guys for "ideas" on how to reform health care for a lot longer time than I will have to. On the other hand, if you grow up and decide to try to fix problems in the real world, maybe we got a shot at making peoples, your peoples, lives a little better.

[By the way, put your last graph in terms of either absolute costs or % of total costs and you get a much more honest picture of what is going on. For example, if in 1980, doctor costs where $100 and administrative costs were 10 cents, a thousand percent increase in admin cost would get you to a dollar, while a 10% increase in the doc's cost would be 10 bucks - or ten times more money coming out of your pocket for the doc that for admin. Ain't math fun?
Also, kind of interesting (to be kind) for someone who railed against the HRC bills as only addressing the insurance/administrative cost and not REAL health care costs. But, that's what ideologue blinders do. ]

Originally Posted by K-I-A 67

I wunder what the government chart looks like? Let me guess, it would look like there's to many chiefs and not enough indians.

With all the yankng, doesn't that nose ring ever get uncomfortable?

Originally Posted by independent

Pretty similar, except with waaaaaaaaay more growth under Reagan & Bush

Gee, I thought Reagan was elected after Wilson, Roosevelt, Kennedy and Johnson were elected.

Originally Posted by The Rani

That last graph says it all. I was thinking the other day that any time a non-clinician with a financial motive is making decisions about health care, both physicians and patients are screwed.

yea, let's go back to making house calls and the barter system for 300 million people.

Since you have a thing against making bacon, what are you going to do with all those pigs KIA will keep giving you for helping him with his growing confusion?

Originally Posted by playwrite

With all the yankng, doesn't that nose ring ever get uncomfortable?

Dude, the only person is always trying to yank my nose ring is you.

Originally Posted by K-I-A 67

Dude, the only person is always trying to yank my nose ring is you.

Yea, show me where I've ever tried to feed you some horseshit data or graphic.

Originally Posted by The Rani

I'll accept sexual favors.

Damn, I have to signoff now, and think that one over.

Originally Posted by independent

We could use pre-1980 levels of administration rather than locking it in at mid-90s rates of waste:




But I guess in your world, the "real world," we're only allowed to ask for a few extra inches of slack on the leash. Don't rock the boat or we might not get any crumbs! What a joke.

OMG! Goddamn parasitic wastes of oxygen.

What use is there electing a "Democrat" that is just a Republican with a D after his/her name?

Originally Posted by playwrite

[By the way, put your last graph in terms of either absolute costs or % of total costs and you get a much more honest picture of what is going on. For example, if in 1980, doctor costs where $100 and administrative costs were 10 cents, a thousand percent increase in admin cost would get you to a dollar, while a 10% increase in the doc's cost would be 10 bucks - or ten times more money coming out of your pocket for the doc that for admin. Ain't math fun?

Gee, a smart person can figure out 1000 x.10 cents = 100$. Ain't math fun!

Originally Posted by The Rani

I'll accept sexual favors.

What would I have to do for a physical?

Originally Posted by K-I-A 67

Gee, a smart person can figure out 1000 x.10 cents = 100$. Ain't math fun!

An even smarter person could figure out that 1000% is 10x not 100x.

What would I have to do for a physical?

Be a pig, evidently. You should find that easy enough.

Originally Posted by The Rani

I'll accept sexual favors.

No surprises there.

Originally Posted by Brian Rush

An even smarter person could figure out that 1000% is 10x not 100x.



Be a pig, evidently. You should find that easy enough.

An even smarter person would think 10 cents sounds pretty unrealistic and 10 dollars sounds about right.

Originally Posted by The Rani

Originally Posted by K-I-A 67

An even smarter person would think 10 cents sounds pretty unrealistic and 10 dollars sounds about right.

The smartest person of all would think that the exact dollar amounts are less important than whether the administrative costs are picked up by the docs themselves or by outside agencies.

No, the smartest person would wonder why adminstartive costs need to be a factor at all. In France, everything is automated, and adminstative costs are less than 1% by all parties combined.

Originally Posted by Marx & Lennon

No, the smartest person would wonder why adminstartive costs need to be a factor at all. In France, everything is automated, and adminstative costs are less than 1% by all parties combined.

Very true. Imitating the French system, or some other national health care system that's been shown to work well, would have been the ideal move in terms of HCR. Unfortunately, it was politically impossible -- for now.

However, that doesn't mean that the reform bill as it exists isn't worth passing. It will do a lot to improve the U.S. health care system, and set a precedent making further reform much easier down the road.

Originally Posted by Bob Butler 54

Here we have Krugman again on health care, saying Pass the Bill. Nothing very new at the start, but he strikes a different note at the end. For discussion purposes...



Jay Leno put it a bit differently. He thinks the senate ought to experiment with a new concept.... majority rule.

I've been hearing people saying we ought to change the cloture rules more and more of late. I'm starting to think a majority rule system might be more central to creating a true regeneracy than supposedly 'major' issues like Afghanistan, health care, the economy or global warming.

The way things are going, the Democrats might not be able to do enough to please the People before the 2010 and 2012 election cycles come around. A rules change might be really big.

I used to use Robert's Rules of Order a bit. Each speaker would be given a certain amount of time to speak, with more time granted by a majority vote. The current Senate system has every debate in principle able to go on forever, with a 60% super majority required to end the talk and bring about a vote. This effectively allows 40% plus one Senators to veto legislation.

I like Robert's system better.

Why not just go back to the old rules? Make 'em do it old school.

Under the old rules you needed two thirds of the senators present to invoke cloture. You could sneak in a quorum of bill supporters in the middle of the night and invoke cloture. To prevent this it was necessary to have someone continuously speaking 24/7. As long as they hold the floor you cannot invoke cloture, giving the bill oppoents time to get enough of their members into the chamber to prevent cloture. So doing a fillibuster came down to simply talking interminably.

Under the modern rules all you need is 3/5 of all senators, they don't have to be present in the chamber to count. So one can fillibuster without having to speak continuously. Makes it a lot easier to fillibuster, which is why it's used so much.