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No bill is better than a bad bill

Obama disagrees of course, but he has poll numbers and midterms to think about. Ditto the wannabe insiders and career liberals and "public option" (or "plan") advocates. I've got my health to think about, and that of my friends. Nothing to date has re-assured me that we won't end up with a mandate that forces millions of us to pay for junk insurance, leaving all us unterbussen worse off than before.

Just look at the list of unresolved issues in the AP story linked to above, and tell me you've got confidence that the sausage that comes out of the FKDP's machine won't be shit.

NOTE Bernie Sanders shows how the sausage was made for Medicare Part D. It looks to me like both administrations went to the same cooking school.

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DCblogger's picture
Submitted by DCblogger on

the politics of a bad bill are worse than no bill. being forced to buy junk insurance will turn the people against the Dems more than anything I can think of.

Submitted by lambert on

... in 2013. Not be be cynical.

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

BDBlue's picture
Submitted by BDBlue on

I can think of a lot worse things than Dems losing seats in 2010 because they sold the economy to Wall Street and healthcare to Big Medicine. They need to be reminded who their base is.

"Do what you feel in your heart to be right -- for you'll be criticized anyway. You'll be damned if you do, and damned if you don't. " - Eleanor Roosevelt

gqmartinez's picture
Submitted by gqmartinez on

Oddly, the hopey changey brigade have brought me to a higher level of cynicism than I've ever had (and my political consciousness was shaped during the Contract with America, more on that later). Normally I'd disagree with the no bil argument when it comes to health care, but I do see this crop of opportunistic peasant haters drafting a bill that will leave all but the healthiest/wealthiest worse off. Sort of an anti-Rawlsian ideal.

Thanks, progs, for turning this optimistic person into a cranky old man decades before my time.

Only tyrants rig elections.

deniseb's picture
Submitted by deniseb on

and my cynicism goes back to the Gulf of Tonkin.

a little night musing's picture
Submitted by a little night ... on

Is history about to repeat itself? I am most interested by Ted Kennedy's actions in this: [my emphasis]

So here's a question that few have asked, and that virtually no one knows the answer to: How important is conference committee to the way the White House is looking at health care? I've heard it's pretty important. Heard the same thing about Harry Reid, actually. If that's true, then this is what the Democratic leadership is thinking: The overriding imperative right now is to keep health reform alive. That's all that matters. Get it out of the Finance Committee. Get it off the Senate floor. If it's cut down to half a loaf, fine. You don't fix it now. You fix it in conference. Or you let Henry Waxman do it for you.

That, incidentally, is not an unprecedented strategy. It's what the Bush administration did with Medicare Part D. The expansion the Senate wrote was genuinely bipartisan: Ted Kennedy and Tom Daschle both voted for the legislation. But the version that came out of conference committee was significantly more conservative. Kennedy and Daschle abandoned the bill. Democrats began organizing against legislation they had previously supported. It passed anyway.

It passed because it's hard to filibuster bills emerging from conference. You can't change them, for one thing. No amendments are allowed. Nor is there time for debate. You vote for the bill, you vote against the bill, or you filibuster the bill. Those are your options. Democrats are likely to walk out of conference committee with 60 senators in their party. Ben Nelson will not be able to ask to change this bit he doesn't like, and Evan Bayh will not be allowed to offer an amendment weakening that piece. They stand with the White House or against it. And it is, in the estimation of most observers I've talked to, hard to imagine them literally filibustering the final vote on health reform. The White House would torture them until they lost reelection. And if no Democrats are willing to filibuster, then the White House could lose as many as 10 of them and still pass the bill.

With a Democratic president whipping, and we know Obama can whip with the best/worst of them, how many in this Congress would have the courage to abandon a bill gone bad? (Especially Representatives, who always have re-election campaigns lurking.)

We can't afford not to have Improved and Enhanced Medicare For All!!

Submitted by lambert on

"Gone bad" for whom?

On of the attractions of single payer for me is that it eliminates so much of the gaming. Of course, people paid good money for the rents from those games...

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

DCblogger's picture
Submitted by DCblogger on

I suppose there is a remote possibility that if we got a bad bill Sanders would filibuster it with the support of Conservative Republicans. We could have a truly weird filibuster.

a little night musing's picture
Submitted by a little night ... on

WSJ editorial on Romneycare and "Obamacare":

For 15 years Massachusetts has also imposed mandates known as guaranteed issue and community rating -- meaning that insurers must cover anyone who applies, regardless of health or pre-existing conditions, and also charge everyone the same premium (or close to it). Yet these mandates allow people to wait until they're sick, or just before they're about to incur major medical expenses, to buy insurance. This drives up costs for everyone else, which helps explain why small-group coverage in Massachusetts is so much more expensive than in most of the country. Mr. Romney argued -- as Democrats are arguing now -- that the individual mandate would make that problem disappear, since everyone is always supposed to be covered.

Well, the returns are rolling in, and a useful case study comes from the community-based health plan Harvard-Pilgrim. CEO Charlie Baker reports that his company has seen an "astonishing" uptick in people buying coverage for a few months at a time, running up high medical bills, and then dumping the policy after treatment is completed and paid for. Harvard-Pilgrim estimates that between April 2008 and March 2009, about 40% of its new enrollees stayed with it for fewer than five months and on average incurred about $2,400 per person in monthly medical expenses. That's about 600% higher than Harvard-Pilgrim would have otherwise expected.

The individual mandate penalty for not having coverage is only about $900, so people seem to be gaming the Massachusetts system. "This is a problem," Mr. Baker writes on his blog, in the understatement of the year. "It is raising the prices paid by individuals and small businesses who are doing the right thing by purchasing twelve months of health insurance, and it's turning the whole notion of shared responsibility on its ear."

This being the WSJ editorial pages, their solution is that the mandate should be removed (and community rating abolished, perhaps?).

Mr. Baker is right, though he underestimates the extent to which it is rational for people to do this, considering the government-mandated incentives. To one degree or another all insurance pools require the younger and healthier to subsidize the older and sicker, though part of the risk-sharing bargain is the hedge against unanticipated or future health problems -- i.e., true insurance. The combination of guaranteed issue and community rating actively encourages parts of the healthier population to forgo coverage and thus blow up voluntary risk pools. No doubt our politicians will conclude that the solution is to raise the penalty for going uninsured, though it would be easier and more rational to let insurance markets function without mandates.

Single-payer solves this problem by covering everyone automatically and also charging everyone automatically. I could phrase this in a less attractive way by saying that it removes the element of choice from the question of whether to have and pay for health insurance. "Choice" has become such an automatic element of the discussion of health care reform that I am very much afraid that this is how it would be phrased.

This is why I think it is very important how we talk about these things, as I've said before here and here.

Emphasize the element of choice, sure - when talking about choosing doctors, hospitals, etc. Right now I suspect most people with health insurance can't really choose which doctor they see, not if they want to have their visits covered. (Like my mom, I get a "choice" from a menu of doctors, none of whom is the woman who used to be my PCP: my health insurance plan at work was changed and she does not participate in my current HMO.)

But when we talk about coverage, we must emphasize the social justice aspect. No, I'd go farther than that: it is just purely patriotic, especially in tough economic times, that we as a society make sure that everyone is taken care of and no one slips through the cracks. I find it completely unacceptable that the HELP committee seems to think it is OK to let even 3% of us go without coverage just to push through a bill that allows the insurance companies to go on profiting from our misery. I find it completely unacceptable that their plan seems to be designed to force my son to stay with his current employer-provided plan, for which he pays a hefty part of the premium, but which has (so far) not paid for much of the care he needs.

This is America. We take care of each other. That's how it should be.

[Yes, I want to elevate this to a whole post centered around LBJ's words on Medicare, but I'm too rushed to write it at the moment.]

--------------------------------

P.S. the WSJ editorial ends in this rather telling paragraph: [my emphasis]

For many Democrats, none of this is really a surprise, or even important. Their Rube Goldberg rules are meant to transfer the costs of health care away from individuals and onto someone else -- private companies like Harvard-Pilgrim in the short term, and over time onto taxpayers.

Hmm. "individuals" != "taxpayers"?

We can't afford not to have Improved and Enhanced Medicare For All!!

Submitted by lambert on

Thanks. If the insurance companies can game the system, so can we. Fair's fair...

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

mass's picture
Submitted by mass on

"The individual mandate penalty for not having coverage is only about $900, so people seem to be gaming the Massachusetts system." This is demonstratively false. The only ones "gaming the system" are the insurers, who thanks to my Democratic legislature and former Republican Governor, now have a large, guaranteed customer base, with which they can continue, unabated, to raise premiums on.

The liberty of democracy is not safe if people tolerate growth of private power to a point where it becomes stronger than their democratic state itself. That, in its essence, is fascism.---FDR

a little night musing's picture
Submitted by a little night ... on

Then please give the evidence. (I'm serious, not snarking.) It would be very useful.

The WSJ editorial, much as I hate its concluding paragraphs, provided evidence of what they referred to as people gaming the system: the report which described people buying insurance only for a short period of time when they needed it and cramming all their health care seeking into that period.

Well, the returns are rolling in, and a useful case study comes from the community-based health plan Harvard-Pilgrim. CEO Charlie Baker reports that his company has seen an "astonishing" uptick in people buying coverage for a few months at a time, running up high medical bills, and then dumping the policy after treatment is completed and paid for. Harvard-Pilgrim estimates that between April 2008 and March 2009, about 40% of its new enrollees stayed with it for fewer than five months and on average incurred about $2,400 per person in monthly medical expenses. That's about 600% higher than Harvard-Pilgrim would have otherwise expected.

If this does not go on, or only in a few isolated instances, it would be really good to be able to point to evidence of that.

(It actually does seem rational that people would behave as the editorial reports. The problem for me is that it's almost too rational, requring an amount of planning that I fear most people are not up to, especially when dealing with the other consequences of health care problems. So I'd really like to see actual data, as opposed to assertions. Unfortunately the WSJ editor did not see fit to link his source, which seems to be Charlie Baker's blog. I couldn't find the specific reference in the time I had, but poking around the blog reveals that Baker is in substantial harmony with the views put forth on the editorial pages of the WSJ. Oh, and he's running for governor!)

(P.S. I think you meant "demonstrably false", but, whatever.)

We can't afford not to have Improved and Enhanced Medicare For All!!

Submitted by lambert on

1. RomneyCare guarantees the market ($900 minimum)

2. People pay the $900, get care, and then stop the premiums?

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

a little night musing's picture
Submitted by a little night ... on

And, like you, I'd be very cheerful if people were, in droves, gaming this sucky system. Since we know (because of testimony offered to the Senate, among other things) that the insurers are doing so.

It's just that, if we're going to make assertions about how people are acting, as a member of the reality-based community I'd like to see them backed up with actual evidence.

Also, my goal is not to have a system where all players game and are gamed in return. My goal is social justice. (I'm not saying you're not agreeing; just want to get that on the record.)

We can't afford not to have Improved and Enhanced Medicare For All!!

Valhalla's picture
Submitted by Valhalla on

It's always a bit suspicious when huge numbers are thrown around like that -- a 600% increase? What was the base number, what percent of their enrollment does that represent, what percent of their costs, etc etc. What kind of medical bills are these people racking up? Chemo? Surgery? Or are people just going in and hanging with their docs once a week? (somehow I'm doubting the last bit). Are these people who just lost their jobs? think they'll lose their jobs? 600% sounds like a scary huge number, but it's not nec. a significant one.

Anecdotally, members of my family run a 'small business' and to hear them talk it's the stupid way Romneycare is enforced that's killing them. And also anecdotally, most of the people I know with enough planning skills and such nec. to 'game the system' are also the people who have enough money to hire tax planners, aka, people who could afford health insurance anyway.

Because the problem is not that we have too little condescension from our tribe. -- okanogen

mass's picture
Submitted by mass on

People can not afford the private insurance mandate, nor high cost health care. So when the latter exceeds the former they buy health insurance, once the former again exceeds the latter, they drop it, at great risk to their own health. That's not "gaming". That's finding a way to live within a terrible system.

The liberty of democracy is not safe if people tolerate growth of private power to a point where it becomes stronger than their democratic state itself. That, in its essence, is fascism.---FDR

michaelwb's picture
Submitted by michaelwb on

"No bill is better than a bad bill"

Well Obama disagrees when comes to health care.

And agreed with it when it came to capping credit card interest rates.

But it is easy to understand when you realize he stands on whichever side pleases the big companies supporting him and doesn't actually help the average worker.

Whoops, my cynicism is showing...

a little night musing's picture
Submitted by a little night ... on

I've been commenting on a post at Pal M.D.'s blog in which he reports that his patients express concerns that sound like right-wing talking points. (which may say as much about what kind of patients he has as anything)

He asks, more or less rhetorically (because he then goes on to answer it):

But what should we really fear about health care reform? The answer of course depends on your position and ideology. I of course hope that something is done about reimbursement for primary care physicians, but that's one issue of many. Leaving aside for a moment the cost containment elephant in the room, what ideologic fears might we have?

Maybe other people want to add theirs. I don't always agree with Pal M.D., but he has a pretty good blog. I'm not asking for people to pile on. It's just another place to make our concerns known to a possibly different audience.

We can't afford not to have Improved and Enhanced Medicare For All!!