Actually, I have to wonder why James is working so hard to defend the Republican Party as it now stands. From all of his posts to date, he disagrees with them as vehemently as I do, if not in quite the same way. Perhaps, James, you think that if the nut jobs who have taken over the party remain viable, we can end up triangulating between them and the Democrats to something you'd approve of?

That's not how it works, though. When a radical position with no grasp of reality is asserted, as is usually the case early in a 4T, it needs to go down to defeat -- total, uncompromising, absolute defeat -- before serious discussions can even begin. When they do begin, those discussions will take place between positions like yours and positions like mine, with yours being the default, i.e., mine have to prove themselves needed and workable or else we stick with yours. Whether one is a progressive or a (real) conservative, that's a better arrangement than letting the inmates run the asylum, which is what we have going on now.

Originally Posted by Brian Rush

Actually, I have to wonder why James is working so hard to defend the Republican Party as it now stands. From all of his posts to date, he disagrees with them as vehemently as I do, if not in quite the same way.

I like that someone from either party had the guts to propose a solution to a problem that is bringing the country to its knees. The ACA did nothing on the cost side. We had the chance to do something and we failed. Now someone comes along with a possible solution and the democrats want to demagogue it. Unfortunately, it will probably work in the short run. In the medium run, the democratic position is completely irresponsible. We cannot afford "Medicare as we know it".

Its hard for me to take seriously a party which has cannot even pass a budget. There were five budgets voted on in the Senate in recent weeks and the democrats voted against every one. They are becoming the party of complete cynicism.

Why would anyone defend them?

James50

Originally Posted by James50

I like that someone from either party had the guts to propose a solution to a problem that is bringing the country to its knees.

http://cpc.grijalva.house.gov/index.cfm?sectionid=70

The Democrats have made a number of proposals in regard to both Medicare in specific and the budget in general. What they haven't been able to do is to pass any legislation enacting their proposals. And of course, neither have the Republicans. That's what divided government accomplishes.

The most concrete Democratic proposal is to give Medicare authority to bargain for lower health-care costs. That's a solution to the cost problem. Whether or not it would work, it actually IS a solution, whereas the Republicans have offered only to kill the program altogether.

Now someone comes along with a possible solution and the democrats want to demagogue it.

It ISN'T a possible solution, and telling the simple truth about a proposal is not "demagoguing" it. The problem is runaway medical costs. The Ryan plan would do nothing to address those costs. It would, to be sure, address the problem of approaching Medicare bankruptcy, but abolishing the program is hardly a "solution."

When the Democrats say that the Ryan proposal would not fix Medicare but kill it, that is not demagoguery. It is simply the truth.

Unfortunately, it will probably work in the short run. In the medium run, the democratic position is completely irresponsible. We cannot afford "Medicare as we know it".

True, but the solution isn't to kill the program but to fix it. And we have to obliterate the proposals to kill the program before we can begin discussing possible solutions.

Its hard for me to take seriously a party which has cannot even pass a budget.

They passed two. They can't pass one now because they don't control the House, and all budgets must originate in the House, not the Senate. But more to the point:

Why would anyone defend them?

http://en.wikipedia.org/wiki/False_dichotomy

The question is why anyone would defend the Republicans as they presently exist, or rather, why YOU would, when you don't agree with them. Whether or not you would defend the Democrats, either, is irrelevant.

Here's what it really comes down to, James. The Republican Party at this time has been taken over by a bunch of wackos. That's not just my opinion, it's also yours. But that's not necessarily a permanent condition. If the GOP as controlled by said wackos goes down to utter, ruinous, ignominious defeat, then the party will reassess its positions and, I predict, come to something rather similar to what you believe. Ideally, what will also happen in that case is that a fair number of conservative Democrats will desert the Democratic Party and become Republicans. We will then have a dialogue in politics between progressive Democrats and conservative (not wacko) Republicans, with the wackos denied any significant representation at all.

So it's best for the nation, for the Democrats, and even for the Republicans that the GOP massively loses next year's election.

Originally Posted by Brian Rush

Here's what it really comes down to, James. The Republican Party at this time has been taken over by a bunch of wackos.

There are wackos in the Republican party, but not among the presidential candidates (at least not yet). Pawlenty, Huntsman, and Romney are not wacko. You may think there policies are totally misguided, that their vision is the opposite of yours, but that does not make them wackos. Palin and Bachmann are not presidential material. That may not keep them from running, but will definitely keep them from being nominated. Interesting article in TNR "The most admirable thing about the current mood in the Republican party." is fun reading.

As for healthcare, I have stated my preference for a single payer system, but that appears unattainable. I would like to see other proposals for Medicare that are fiscally sound, as, if its not fiscally sound, nothing else matters. Ryan has proposed such a plan. I am waiting for the democratic alternative that is not just trolling for votes while kicking the can down the road. We have done that for far too long.

As far as cleansing the Republican party of wackos, I do agree that would be a good thing.

James50

Originally Posted by James50

There are wackos in the Republican party, but not among the presidential candidates (at least not yet).

I was thinking of the Republicans in actual office. There isn't a Republican president; President Obama is a Democrat. Republicans don't control the Senate, either. So I'm looking at the House of Representatives and various state legislatures that the GOP does control.

As for healthcare, I have stated my preference for a single payer system, but that appears unattainable. I would like to see other proposals for Medicare that are fiscally sound, as, if its not fiscally sound, nothing else matters. Ryan has proposed such a plan.

But he hasn't, that's the point. I mean, what's the problem with Medicare? That it's going to run out of money and not be able to provide the benefits it does now, right? It's not just an unbalancing of the federal budget, it's that Medicare provides a great public benefit that its finances render precarious. What Ryan proposes is that Medicare immediately stop providing the benefits it does now. He would abolish the program and replace it with a set of vouchers partially paying the cost of seniors buying private health insurance -- if they can even find a company willing to cover them at any price. So rather than solving the problems with Medicare, Ryan would accelerate them, bringing them to bear on us now rather than at some point down the road. That is NOT a solution!

As for single payer not being politically possible, part of the reason for this is the fact that the Republican Party has been taken over by wackos, so that we triangulate not between progressives and sane conservatives but between sane conservatives and crazies. Single payer is a progressive position and has no significant advocacy in power. The thing is, there are three, not two, main positions in Congress today: progressives like Pelosi and Kucinich, conservatives like many Democrats and a few Republicans (Snow, Lugar, Brown, for example), and reactionaries like Ryan. (I would put the president in the conservative camp overall, although I have a sense that he might move left if the political wind shifts.) The reactionaries are a phenomenon that seems to emerge early in each 4T. They're like the Crown and the Loyalists in the Revolutionary War, the secessionists in the Civil War, or the laissez-faire purists in the early Great Depression years.

Look at what happened in the last Crisis during the first three elections (including 1928). The purists mostly won the 1928 election, even though Herbert Hoover wasn't one of them; then the Depression struck, and their ideas became unpopular. But they still had enough clout in the Republican Party to insist the party toe that line through the 1936 election. After getting their heads handed to them three times running, the GOP changed its tune and began running candidates who accepted the New Deal in principle but argued for a more cautious and conservative approach to it in practice. Take a look at the House election results for the Depression years:

http://en.wikipedia.org/wiki/United_...lections,_1932

http://en.wikipedia.org/wiki/United_...lections,_1934

http://en.wikipedia.org/wiki/United_...lections,_1936

http://en.wikipedia.org/wiki/United_...lections,_1938

http://en.wikipedia.org/wiki/United_...lections,_1940

http://en.wikipedia.org/wiki/United_...lections,_1942

Republican electoral fortunes changed for the better after 1936, as the party changed its approach and policy positions. They achieved great gains in 1938, sharply reducing the Democratic majority in the House. They lost a few seats net in 1940, but not very many, which could itself be considered a victory considering that Roosevelt was reelected in the same election. They achieved more great gains in 1942. This pattern continued until they recaptured Congress in 1946 and the White House in 1952.

What I'm saying is that the Republicans are going to need to go through the same transition. They have tied themselves to policy positions that are simply out of touch with reality and cannot prevail politically, but which are also hurting us by weighting the political dialog away from any solutions that will really solve the problems we face. That's bad for the nation and also bad for the GOP. They only way out of the mess is for them to lose next year's election badly. If they do, that won't result in a progressive majority in Congress; it will result in a conservative majority, because most of the Democrats elected next year will be conservatives. But that's when the dialog can really begin. Conservatism is always the default position. "If it ain't broke, don't fix it," right? Of course, we do have some things that are broke. (In more senses than one.) We'll have some progressive reforms as a result of this Crisis for the same reason as always, because we have no choice. If the Republicans lose next year's election, the loss won't be permanent; they'll come back the same way they did in the late 1940s: sane.

I hear what you are saying, but the analogs to the elections of the 1930s have not held so far. The Republicans had a big victory in 2010. This is very different from 1934 if you are making comparisons with Obama and Roosevelt.

Also, the latest from Washington Post/ABC News poll. Obama loses bin Laden bounce.

Among all Americans, Obama and Romney are knotted at 47 percent each, and among registered voters, the former governor is numerically ahead, 49 percent to 46 percent.

Anything can happen, but the odds of a Republican smashup in 2012 look pretty low right now.

James50

Originally Posted by James50

I hear what you are saying, but the analogs to the elections of the 1930s have not held so far. The Republicans had a big victory in 2010. This is very different from 1934 if you are making comparisons with Obama and Roosevelt.

The political change from R to D in the House and Senate began before the economic meltdown began. The change in the Presidency happened as the economy was already in a rapid and severe meltdown. Voters were disgusted in the dishonesty, corruption, and incompetence of the President in 2006 and believed that the Republicans had little to offer in 2008. People got impatient with economic results in 2010.

The GOP offered some purported solutions in 2010 -- the supposed "magic" of the "free market" -- only to show itself as the harsh medicine of oligarchy and market power. Now that those have been shown inequitable, the Democrats are back in the driver's seat for 2012.

Bait-and-switch in business is good for a quick profit in business at the expense of a gullible customer. In politics it is good for quick payoffs to the well-connected at the expense of everyone else.

Also, the latest from Washington Post/ABC News poll. Obama loses bin Laden bounce.

The President isn't campaigning yet, the GOTV apparatus isn't out yet; Republicans have nothing new to offer. Just look at how unpopular the GOP is. No Presidential nominee has had as effective a campaign as this President. To be sure, there has to be something more than a pitch ... I already see a President above average in almost every aspect of being a President. If a sub-mediocrity like Dubya can win re-election...

Anything can happen, but the odds of a Republican smashup in 2012 look pretty low right now.

James50

Health care? No worries, that good ole Walmart is one stop shopping. Do your grocery shopping, have your tires rotated and get a health screening, all in one store. Gee, maybe the next inovation will be health care in hair salons. You know, get your hair, nails and blood drawn, all in one conveinant stop.

http://drugstorenews.com/article/con...ruts-its-stuff

(THE NEWS: Sam’s Club celebrates men’s health with free screenings. For the full story, click here)

(THE NEWS: MinuteClinic offers free diabetes monitoring package. For the full story, click here)

An estimated 1-in-6 men will develop prostate cancer in their lifetimes. Because of this, the free men’s health screenings that Unilever is sponsoring over the weekend at Sam’s Club stores, provided by Carmen Ingle & Associates, indicate of just how much potential retailers have to address even some of the most serious health crises.

A nurse practitioner doesn’t have the education or specialization of an oncologist, and while Sam’s Club doesn’t have clinics, it shows that retailers can offer some of the same services as physician offices and thus reduce the burden on them, all the while doing so at a lower price. That, in turn, can help lower the burden on people buying their own health insurance and payers, as well as the employers — including many of the small business owners who are Sam’s Club members — that will be required to buy medical insurance for their employees under the healthcare-reform law.

In addition to Sam’s Club, CVS Caremark’s MinuteClinic locations will offer a package of diabetes management services this summer. With diabetes — mostly Type 2 — affecting nearly 26 million Americans, retailers are in an ideal position to do a lot to help mitigate the epidemic.

Regardless of the amount of money healthcare reform saves the system overall, these kinds of services offer another dimension of savings by providing low-cost, walk-in care, especially now that the model is changing to expand from acute care to detection and management of chronic disease states.

Check this graph out -




Notice where the private sector (versus the government) is the primary mechanism of insuring health protection that health costs are much greater?

Hmm, only in Idiot America.

Originally Posted by James50

I hear what you are saying, but the analogs to the elections of the 1930s have not held so far. The Republicans had a big victory in 2010. This is very different from 1934 if you are making comparisons with Obama and Roosevelt.

Actually, we're a little earlier in the Crisis than that; 2012 is like 1932, not 1936. Except there's a different dynamic this time around. What I'm anticipating is a HUGE backlash against the Republican Party, which is the focus of popular ire at this time. Obama is almost sure to win reelectoin but I'm not necessarily anticipating an enormous blowout in the presidential; I'm looking more at Congress, because that's where the GOP is suffering a backlash. (I mean, if Obama barely wins, he still wins.)

Here's what I'm seeing. The Republicans are making the same mistake you did above. They did not have a "big victory" in 2010. They had a victory by default. Very few people changed their minds between 2008 and 2010. What happened is that a lot of people who voted for Obama became disillusioned with him, but most of those people didn't vote Republican, they just didn't vote period. The Republicans received the votes of only a little more than 20 percent of the eligible electorate (given 41% turnout and the fact that they had a majority). Now, regardless, the law says that this means the Republicans control the House of Representatives and quite a few state houses today. Well and good -- but the meaning of the election still matters, and the Republicans have made a BIG mistake in interpreting that meaning.

Because they took the 2010 electoral outcome to be a mandate and an indication that the American people had turned their backs on liberalism, they have taken action which they wouldn't have done if they had understood properly what really happened. Because they have done this, the people are up in arms, utterly rejecting the proposal to dismantle Medicare, seething at the unwillingness of the GOP House to even consider raising taxes on the rich, and mounting serious efforts to recall state legislators who voted to crack down on union bargaining rights in Wisconsin. The Republicans have put the right-wing agenda of the "conservative" movement and the Tea Party front and center and made them issues, and the people are against these things.

So I expect next year's vote to be a referendum on that agenda more than anything else, even more than a referendum on the Obama presidency. The outcome I'm expecting will not be a victory for the progressives so much as a crushing defeat for the "conservative" movement; as I said, most of the winners of next year's election will likely be conservatives -- not "conservatives," but real conservatives. This will clear the field, so to speak, in preparation for the dialogue between conservatives and progressives which must result in the compromise enacting Crisis-era reform. Progressives won't win everything; we never do. But the first act has to be the utter defeat of the reactionaries. Then we can see where it comes down in the end.

Originally Posted by James50

From Fark: "Why we must embrace Paul Ryan's plan to end Medicare as we know it, as reported by that notorious right-wing fascist publication, Newsweek"

Here.

James50

In the end, as Playwrite's graph indicates, publicly administered health care systems do a better job at containing health care costs than private systems, so if medicare can't provide effective health-care to the elderly that our society can afford, nothing will be able to.

What Samuelson's article glosses over is the difference between total health care costs and costs to individuals. What Ryan's plan does is replace the current medicare program where the elderly are provided a defined set of benefits with one where the elderly are given a set amount of money whose amount is indexed to inflation, not health care costs (which are rising faster than inflation, hence the "problem"). If the allowance doesn't cover the full expense of the procedure, and the patient can't pay for it out of pocket, then they don't get the care.

I love how Samuelson's argument against the CBO's projection that the Ryan plan will actually cause health care costs to be a third higher than under current version of medicare is just "Well, what if they're wrong"? I dunno Paul, what if they're wrong about the future deficits? Then we don't need to worry, do we? According to him we are supposed to take CBO reports at face value when they predict horrible deficits, but not when they predict something inconvenient to his argument.

He points to the fact that an earlier CBO prediction about the cost of the new medicare drug benefit was overestimated by 42 percent, and that the managed care plans in Medicare do not have higher cost than the fee for service plans under medicare that offer similar benefits, as evidence to support his argument that Ryan's plan will be able to cover more people, and hold down more costs than its critics say.

His second point is completely disingenuous because Medicare Advantage is structured completely differently than Ryan's plan. Under Medicare advantage, the private plans are required to offer a certain defined set of benefits, and, if medicare beneficiaries choose, they can opt for coverage under medicare that offers pretty much the same benefits. In effect, it a version of Obamacare with a very strong public option to hold down costs. The Ryan plan is completely different. There are no requirements as to what kind of benefits insurance companies need to offer, and no public option to hold down costs.

His first point is irrelevant since it is a short term evaluation of a CBO cost projection of a small component of overall health care in this country. Far more relevant would be to ignore the CBO entirely, and instead compare Ryan's plan with a similar "program" already in place - the private insurance market in the U.S. before the implementation of the Affordable Care Act.

According to Samuelson, with their new coupons from the government, elderly people are supposed to be somehow "empowered" to bargain with health insurance companies to lower prices. Its the magic market fairy again. If individuals now are not able to bargain with insurance companies in order to afford health care, why would the elderly suddenly be able to? If even large corporations can't use their size and bargaining power to control health care costs when they bargain for employee benefits, why would individual elderly people succeed where they fail?

Finally, the most galling part of Samuelson's article is that it ignores the fact that the Affordable Care Act already implements programs that move away from fee-for-service, which is what Samuelson bemoans as one of the primary causes of rising health causes, and what he says Ryan's plan is somehow supposed to address.

http://dpc.senate.gov/healthreformbill/healthbill25.pdf

In the end, health care is going to getting more expensive because more of it is available and a greater proportion of the population is getting older, so they will consume more health care. Publicly administered health care systems do a better job of containing costs than private systems, especially private systems that depend entirely on the "market" as a method of cost control. Still, we will most likely need to pay slightly more into medicare starting towards the end of the next decade absent drastic reforms such as the implementation of a medicare for all system.

I am willing to do that rather than abandon elderly people to a lack of care.

As to Neweek's ideology - I haven't read it in a long time, but from what I remember it tried to convey what it considered a range of views, from liberal, to "centrist", to conservative. The "liberal's" generally focused on issues like the environment, gay rights, or poverty, the "conservatives" generally focused raged against the government in all forms and cultural immorality, and the "centrists" generally portrayed themselves as liberal socially, fine with such government actions as environmental protection, but very, very concerned about entitlements, deficits, and what they might do the bond market. If I remember correctly Samuelson took the "centrist" view.

Me personally - I remember a time, way back in the year 2000, when the idea that the government should undertake deficit spending during times of recession and high unemployment was a plank of both the Republican, and the Democratic parties. I remember a when both parties at least gave lip service to caring about such issues like education.

Now it seems like the "moderate", "reasonable" message is to shoot the kids and throw old people off a cliff because we can't "afford" it. (I'm sorry, not old people now, but people that will be old in a couple years)

Sorry, not buying it.

Originally Posted by Brian Rush

So I expect next year's vote to be a referendum on that agenda more than anything else, even more than a referendum on the Obama presidency. The outcome I'm expecting will not be a victory for the progressives so much as a crushing defeat for the "conservative" movement; as I said, most of the winners of next year's election will likely be conservatives -- not "conservatives," but real conservatives. This will clear the field, so to speak, in preparation for the dialogue between conservatives and progressives which must result in the compromise enacting Crisis-era reform. Progressives won't win everything; we never do. But the first act has to be the utter defeat of the reactionaries. Then we can see where it comes down in the end.

If we are both still around and contributing to this forum in November, 2012, perhaps we can review this prediction.

James50

Originally Posted by btl2283

In the end, as Playwrite's graph indicates, publicly administered health care systems do a better job at containing health care costs than private systems, so if medicare can't provide effective health-care to the elderly that our society can afford, nothing will be able to.

What Samuelson's article glosses over is the difference between total health care costs and costs to individuals. What Ryan's plan does is replace the current medicare program where the elderly are provided a defined set of benefits with one where the elderly are given a set amount of money whose amount is indexed to inflation, not health care costs (which are rising faster than inflation, hence the "problem"). If the allowance doesn't cover the full expense of the procedure, and the patient can't pay for it out of pocket, then they don't get the care.

I love how Samuelson's argument against the CBO's projection that the Ryan plan will actually cause health care costs to be a third higher than under current version of medicare is just "Well, what if they're wrong"? I dunno Paul, what if they're wrong about the future deficits? Then we don't need to worry, do we? According to him we are supposed to take CBO reports at face value when they predict horrible deficits, but not when they predict something inconvenient to his argument.

He points to the fact that an earlier CBO prediction about the cost of the new medicare drug benefit was overestimated by 42 percent, and that the managed care plans in Medicare do not have higher cost than the fee for service plans under medicare that offer similar benefits, as evidence to support his argument that Ryan's plan will be able to cover more people, and hold down more costs than its critics say.

His second point is completely disingenuous because Medicare Advantage is structured completely differently than Ryan's plan. Under Medicare advantage, the private plans are required to offer a certain defined set of benefits, and, if medicare beneficiaries choose, they can opt for coverage under medicare that offers pretty much the same benefits. In effect, it a version of Obamacare with a very strong public option to hold down costs. The Ryan plan is completely different. There are no requirements as to what kind of benefits insurance companies need to offer, and no public option to hold down costs.

His first point is irrelevant since it is a short term evaluation of a CBO cost projection of a small component of overall health care in this country. Far more relevant would be to ignore the CBO entirely, and instead compare Ryan's plan with a similar "program" already in place - the private insurance market in the U.S. before the implementation of the Affordable Care Act.

According to Samuelson, with their new coupons from the government, elderly people are supposed to be somehow "empowered" to bargain with health insurance companies to lower prices. Its the magic market fairy again. If individuals now are not able to bargain with insurance companies in order to afford health care, why would the elderly suddenly be able to? If even large corporations can't use their size and bargaining power to control health care costs when they bargain for employee benefits, why would individual elderly people succeed where they fail?

Finally, the most galling part of Samuelson's article is that it ignores the fact that the Affordable Care Act already implements programs that move away from fee-for-service, which is what Samuelson bemoans as one of the primary causes of rising health causes, and what he says Ryan's plan is somehow supposed to address.

http://dpc.senate.gov/healthreformbill/healthbill25.pdf

In the end, health care is going to getting more expensive because more of it is available and a greater proportion of the population is getting older, so they will consume more health care. Publicly administered health care systems do a better job of containing costs than private systems, especially private systems that depend entirely on the "market" as a method of cost control. Still, we will most likely need to pay slightly more into medicare starting towards the end of the next decade absent drastic reforms such as the implementation of a medicare for all system.

I am willing to do that rather than abandon elderly people to a lack of care.

Excellent post! Informative and highly reasoned.

You'll find similar from several posters that have Left-leaning viewpoints; you will find the forum nearly devoid of such from any voices on the Right. Can be frustrating at times - I miss the days of true conservatism.

Originally Posted by James50

From Fark: "Why we must embrace Paul Ryan's plan to end Medicare as we know it, as reported by that notorious right-wing fascist publication, Newsweek"

Here.

James50

What would otherwise be hilarious, if not so sad, would be to take Samuelson in full-bore alarmist leap (that would make Ayn Rand blush) and present him with this graphic that you have seen before -




I can hear it now: "My god man, are you crazy?!!! Raise the top rate from 35% to 39% - a whole 4%?!!! Return us to that pitiful economy, if not slavery or pinko commie land, of the Clinton boom years??!!!! Just so we can solve this little deficit problem? Just so we can solve these little SS and Medicare and Medicaid problems? No, no, we can't do that!!! We must throw grandma off the clift!!! .... For the children, you know?"

Originally Posted by James50

Quote Originally Posted by Brian Rush

So I expect next year's vote to be a referendum on that agenda more than anything else, even more than a referendum on the Obama presidency. The outcome I'm expecting will not be a victory for the progressives so much as a crushing defeat for the "conservative" movement; as I said, most of the winners of next year's election will likely be conservatives -- not "conservatives," but real conservatives. This will clear the field, so to speak, in preparation for the dialogue between conservatives and progressives which must result in the compromise enacting Crisis-era reform. Progressives won't win everything; we never do. But the first act has to be the utter defeat of the reactionaries. Then we can see where it comes down in the end.

If we are both still around and contributing to this forum in November, 2012, perhaps we can review this prediction.

James50

Include me... in.

One of the paradoxical results of the 2012 election could be the revival of conservatism -- but instead of a conservatism based on captive markets, elite privilege, semi-racist demagoguery, and anti-intellectualism we will find a new conservatism with much more caution, conscience, kindness -- and rationality. All Presidential elections have their own uniqueness, but here is the stunning oddity of 2008: highly-educated white people voted for the comparatively-liberal President Obama, but poorly-educated white people rejected Barack Obama wildly. Poorly-educated white people used to be a reliable group of Democratic voters, and they were as late as 1996.

Was it race? Maybe. Perhaps poorly-educated white people are less likely to see black people in positions of power of any kind. Now some black man is President of the United States, the man wielding power that a Caesar or a tsar could have hardly imagined. Will he be seen as wielding that power well? We shall see in 2012. So far this President is above average on everything except management of the economy. Could anyone do better? If the economy improves by 2012, then the President will get the credit. If the economy falters, then there will be the question of who gets the fault.

I have studied most of the Presidential elections of the 20th century... and I see some remarkable patterns. One is that political realignments happen under the cover of landslide defeats. A prime example is the three landslide Republican wins of the Presidency in 1980, 1984, and 1988. In 1976, Jimmy Carter was the last Democratic nominee to win the Presidency while depending upon Southern states. Carter won every former Confederate state except Virginia, including states (Texas, Mississippi, Alabama, and South Carolina) that the Democrats haven't won since. Carter was also the last Democrat to win the Presidency without many states (including California, Oregon, Washington, Nevada, Iowa, Illinois, New Mexico, Connecticut, New Jersey, Vermont, New Hampshire, Maine that the Democrats have won in every win since 1976.

Political parties usually have coalitions that have the potential for winning -- but sometimes those coalitions erode. The New Deal coalition that formed about 1930 finally aged into irrelevancy in the 1980s. Sure, Carter was a flop... but what was so awful about Walter Mondale that he would be clobbered as he was in 1984? He wasn't an extremist or a corrupt pol. He had plenty of political experience. Bland and dull? Sure. The New Deal coalition may have convinced the GI Generation but not Boomers or Generation X.

Many thought -- and I was one of them -- that the Democrats were going to be excluded from the Presidency for a long time -- until Bill Clinton picked up a bunch of states that Democrats just did not win on Election Night, 1992. Democrats built a new coalition based on values (like environmentalism) not particularly associated with the New Deal Coalition... and won.

Democratic politicians have a new coalition -- non-white minorities, religious minorities, feminists, and debtors. The Republicans have relied heavily upon the Religious Right, a largely-Boomer constituency. The Religious Right is not a growing coalition. Boomers, and hence the Religious Right, are entering the age groups in which their death rates take off. The Religious Right isn't winning many converts, and it isn't holding onto the youth.

Considering that I am in treatment for cancer, I have to regard myself as lucky. What if you are living in a shelter, in a tent, or on the street? To get a severe illness with no kind of health insurance/coverage?

Originally Posted by TimWalker

Considering that I am in treatment for cancer, I have to regard myself as lucky. What if you are living in a shelter, in a tent, or on the street? To get a severe illness with no kind of health insurance/coverage?

You bring up a point I have often wondered about. To what extent do the indigent get care? Medicaid covers a lot of people, but I think you have to have an address to get it. If you are so poor, ill, addicted, or mentally ill that you are actually homeless, I am not sure what happens. I do have an anecdote in my family about the sister of my BIL who raised a family on a farm in Illinois. She did not have medical insurance and developed breast cancer. She ended up getting what my BIL thought was state of the art treatment, had a large bill, but ended up paying very little.

I suspect there are stories on both sides.

BTW - how is your treatment going? We have an employee age 31 just diagnosed with stage 4 testicular cancer. Fortunately testicular cancer is very sensitive to chemotherapy. He is going to have a rough few months but is expected to survive. Of course, he has our company insurance.

James50

Originally Posted by James50

We have an employee age 31 just diagnosed with stage 4 testicular cancer. Fortunately testicular cancer is very sensitive to chemotherapy. He is going to have a rough few months but is expected to survive. Of course, he has our company insurance.James50

It will be interesting to see what happens to your health insurance group rate next time around as a result of this employee.

Some years ago it was commonplace for insurance companies to push risk down onto healthcare providers through contracts. For example, my clinical laboratory that I ran contracted with insurance companies based on "capitation agreements." This meant that we would bid against other labs for exclusive contracts. Under the terms of the contract we would be paid a dollar or a bit more per insured person per month ... getting therefore a check each month for the number of insured folks times the capitation rate. Our obligation then was to provide all the lab work that all these folks needed, no matter how much that turned out to be.

In this way the insurance companies are able to divest themselves of many of the components of risk, and the providers of the healthcare itself take on the risk.

In our case with one insurance company in Phoenix that had relatively few insured folks, a few of their folks got HIV which at that time required a lot of very expensive lab tests. These few patients wiped out the small payments that we received through the costs we suffered on their behalf.

I think that since I retired from that industry in 2006, that capitation has declined somewhat, though some still remains.

Interesting isn't it, how the insurance companies squeeze everyone? They'll complain to you, James, how much it costs them to have your cancer patient, while they raise your rates, and then perhaps they'll push the real risk of that patient's treatment down to the providers of the care via capitation agreements!

Originally Posted by TnT

It will be interesting to see what happens to your health insurance group rate next time around as a result of this employee.

Some years ago it was commonplace for insurance companies to push risk down onto healthcare providers through contracts. For example, my clinical laboratory that I ran contracted with insurance companies based on "capitation agreements." This meant that we would bid against other labs for exclusive contracts. Under the terms of the contract we would be paid a dollar or a bit more per insured person per month ... getting therefore a check each month for the number of insured folks times the capitation rate. Our obligation then was to provide all the lab work that all these folks needed, no matter how much that turned out to be.

In this way the insurance companies are able to divest themselves of many of the components of risk, and the providers of the healthcare itself take on the risk.

In our case with one insurance company in Phoenix that had relatively few insured folks, a few of their folks got HIV which at that time required a lot of very expensive lab tests. These few patients wiped out the small payments that we received through the costs we suffered on their behalf.

I think that since I retired from that industry in 2006, that capitation has declined somewhat, though some still remains.

Interesting isn't it, how the insurance companies squeeze everyone? They'll complain to you, James, how much it costs them to have your cancer patient, while they raise your rates, and then perhaps they'll push the real risk of that patient's treatment down to the providers of the care via capitation agreements!

My goodness gracious, I had no idea insurance companies did this. I knew they were greedy but............. I guess that's why they get paid the big bucks. (rolling eyes)

For those interested in not only the lawsuits against the Affordable Care Act (ACA aka Obamacare) and Constitutional Law, but also the near poetry, if not dance, of a well-argued case (3-person panel judges as well as lawyers on all sides) you can't get better that this - the Eleventh Circuit Court of Appeals in Atlanta hearing the government's appeal of the Florida district court's decision that the individual mandate was unconstitutional and voiding the entire act because the mandate provision was not separable from the rest of the act.

It seem pretty dry at first, but if you let yourself get drawn-in, I think you will find it fascinating for not only the arguments but for the cadence of the back-and-forth between the lawyers and the judges. How the lawyers demur to the judges interruptions and respond without missing a beat coupled with how the judges steer the discussion to some near-mysterious distination of the most germane of truths (at least in their eyes). Again fascinating, and I would highly recommend the last 15-20 minutes starting with Michael Carvin of National Fed. of Independent Businesses followed by Neal Katyal arguing the government's position.

http://www.c-spanvideo.org/program/FloridavD


For the argument, it is boiling down to whether or not Congress can require the purchase of a certain good or service (in this case, health insurance) under the Commerce Clause that provides Congress with the authority to regulate interstate commerce. The question goes quickly to the route of whether a decision NOT to purchase something ("inactivity") can be seen as an economic activity beyond the individual to the level of commerce.

There seems to be agreement of the fact that there is $43 billion per year in "uncompensated care" provided to those who "self-insured." There seems to be agreement that this results in a "cost-shift" to those that do pay for their health care (either insured or not) as a result of higher health costs, higher insurance premiums, or higher tax payer burden. There appears to even be agreement that Congress can regulate to deal with the uncompensated care at the point that those who gain such care hit the doors of the emergency room or other health providers - Congress already regulates this by requiring health providers to provide the care whether compensated or not. The question is can Congress regulate in anticipation of uncompensated care - ignore the temporal shift with the assumption that any of us are just an "instant away" from potentially needing such care.

Those arguing against the mandate have tried to make the case of the "slippery slope" of Congress mandating other purchases of good or services (e.g. life, disability, home, flood, liability, business insurance). The judges have asked if there is something unique about health insurance that is not present for other goods and services and therefore be a barrier to avoid the slippery slope of additional mandates. Those arguing for the mandate tried to make the case that the cost-shifting is the uniqueness, but that then gets everyone to the temporal question of allowing Congress to regulate before those seeking "uncompensated care" hit the door of the emergency room.

However, there is another line of thought that causes the route to the temporal question to be devoid at its beginning - the question of can Congress regulate an "inactivity" (not purchasing insurance) under the Commerce Clause.

That alternative line of thought begins with a different, and necessarily earlier, question of the intent of the ACA as being either to regulate (a) health insurance coverage or (b) payment for services in the health care service market. If it is the latter, there is no doubt that Congress can, and has, extensively regulated the health care service market; the individual mandate then is merely a policy choice of "means" to regulate, and a partial one, for meeting the broader goals and objectives of Congress in regulating the commerce of that services market.

A good discussion of this can be found here -

http://www.angrybearblog.com/2011/06...ourt-will.html

with the following key excerpt that is a quote from Santa Clara U. law professor Brad Joondeph -

[A] critical question that every judge must confront (or at least every judge reaching the merits) is whether the minimum coverage provision (a) regulates conduct in the health insurance market (as the challengers contend), or (b) regulates conduct in the health care services market (as the United States maintains).

In a direct and immediate sense, of course, the individual mandate regulates behavior in the insurance market. But one can easily argue (as with §4306 above) that what it really regulates is the payment for services in the health care service market. Sure, the provision, when examined in isolation, only directly concerns the purchase of health insurance. But the broader scheme, taken as a whole, shows that what Congress was actually regulating--of which the individual mandate is only a part--is the financing of health care services. Congress logically cared whether people carry health coverage not for its own sake, but due to its implications for the financing of services in the health care market, the ultimate object of its regulation.

One interesting aspect of this, somewhat currently overlooked, is that the plaintiffs as well as the Florida judge's decision that the mandate is inseparable from the rest of the Act. The rest of the Act has tons of stuff intending to impact the "health care service market." By claiming the individual mandate is inseparably, have they not argued that the mandate is just one of the means of the Act intended to impact the health care service market?

Thanks PW. Good summary.

I am glad I am not one of the judges. From an outcomes point of view, the mandate is appropriate and necessary. Its just I don't like the government making someone buy a product with essentially no choice (this is where the analogy to car insurance breaks down). In my head I am for it, but in my heart, I am against it.

James50

Originally Posted by James50

Thanks PW. Good summary.

I am glad I am not one of the judges. From an outcomes point of view, the mandate is appropriate and necessary. Its just I don't like the government making someone buy a product with essentially no choice (this is where the analogy to car insurance breaks down). In my head I am for it, but in my heart, I am against it.

James50

Yea, it is different. Driving on government-build roads is a privileged that requires a license. As such, most states now require a licensed driver to carry insurance or have a bond to maintain the privilege.

The health insurance mandate is about "free riders" - those that supposedly self-insure but if and when they show up for care, the mandate provision of care is uncompensated by the "free rider" and the cost then shifts the costs to others (higher health costs, insurance premiums or taxes). Put this way, even a Libertarian has to scratch his head and think about their most basic belief that one is free to do whatever [u]as long as it doesn't adversely impact another.[u]

One of the more amusing statements came from Katyal - "this may violate the constitution of Ayn Rand but it does not violate the US Constitution."

http://www.realclearpolitics.com/art..._110086-2.html

If CBO is correct, Ryan's plan fails; beneficiaries' out-of-pocket costs would roughly double to cover the added cost. But CBO may be wrong. When a voucher system was adopted for Medicare's new drug benefit, CBO overestimated its costs by a third; the Centers for Medicare and Medicaid Services' overestimate was 42 percent...

Originally Posted by playwrite

Driving on government-build roads is a privileged that requires a license. As such, most states now require a licensed driver to carry insurance or have a bond to maintain the privilege...

-Bad analogy. No one is forced to buy an automobile.

Originally Posted by playwrite

..."this may violate the constitution of Ayn Rand but it does not violate the US Constitution."

-Nowhere in the US Constitution does it give congress the power to force people to buy a product they don't want.

Originally Posted by playwrite

...The health insurance mandate is about "free riders" - those that supposedly self-insure but if and when they show up for care, the mandate provision of care is uncompensated by the "free rider" and the cost then shifts the costs to others (higher health costs, insurance premiums or taxes). Put this way, even a Libertarian has to scratch his head and think about their most basic belief that one is free to do whatever [u]as long as it doesn't adversely impact another.[u]

Better solutions for Epimetheus include:

1) Attaching future wages (everyone else does it);

2) Private Charity. Since it's such a big concern for the Trust Fund Baby of Manhattan, I'm sure he'll be able to pitch in a bundle...