[I thought I'd update and re-post this, since with HR3962 our GENIUS Dems have really outdone themselves their indefatigable efforts to preserve the two-party system by giving the Republicans ever better odds in 2010 and 2012. Not that it matters to them; they're all made in Versailles by now anyhow. --lambert]

Obviously, I'm not a member of that curious breed, the "Democratic Strategist," nor do I play one on the teebee, nor do I have an interest in joining the League of Triple-A Democratic Strategists as a way to make it into The Show; and anyhow, if I were any good at strategerizing, somebody would be paying me to do it (Inside Rotisserie Baseball commenters take note).

Then again, because I'm not paid [except for your donations!], I can't ignore the obvious on health care insurance reform, and it seems to me that the "some bill, any bill" that the current Congress is going to emit will have some problems down the line. Among them:

1. Pffft. That deflated feeling, as of air escaping from a tire, will come when people compare the promise of "hope" and "change" to what is actually delivered -- and when (2013). As far at the [a|the] [strong|robust]? public [health insurance]? [option|plan], I still think my "baseline scenario" -- the mandate will force millions to buy junk insurance, bailing out the insurance companies -- is the most likely outcome, and it's not going to play well over time, especially with Obama's youthful base [UPDATE See Ian Welsh]. Then again, we might think that the electoral process has become a stepping stone to lucrative jobs on K Street or on the teebee, and so what we think of as the politics or optics of it all is just not relevant to insiders and wannabe insiders.

AP gets the date, in full why oh why can't we have a better press corps mode:

Under the Democratic bills, federal tax credits to help make health insurance affordable for millions of low- and middle-income households won't start flowing until 2013 — after the next presidential election. [Quelle surprise!] But Medicare cuts and a sizable chunk of the tax increases to pay for the overhaul kick in immediately. [Quelle surprise!]

The eat-your-vegetables-first approach is causing heartburn for some Democrats. Three years is a long time to wait for dessert...

Oh, health care is dessert? I guess to the press, who have insurance, it is!

... and opponents could capitalize on misgivings about the complex legislation to undo what would be a signature achievement for Obama.

Obama administration officials and Democratic lawmakers say the reason for the three-year wait is the time it's going to take to set up insurance marketplaces, write consumer protection rules and reconfigure the bureaucracy to carry out the legislation. It took President George W. Bush's administration two years to phase in the Medicare prescription benefit, a more modest undertaking.

Right, and it took LBJ only 1 year to implement Medicare -- before computers! Why?

Cappy McGarr in the Times, today:

Back in the 1990s, I was the founding chairman of Texas’ state-run purchasing alliance — an exchange, essentially — which ultimately failed. There are lessons to be learned from that experience, as well as the similar failures of other states to create useful exchanges.

As the Democrats busily work on plans to make us all captive consumers of the private health insurers, the rich are cutting loose from the system. While we'll be stuck in costly Exchanges, the rich will be moving on toward their own privately reformed health system. Welcome to the world of concierge medicine.

So, yesterday I used up my last dose of a medicine that actually worked for a chronic condition. I had used it for years, with no side effects.

My insurance company up and decided that, instead, I should be a guinea pig for medicines that didn't impinge so much on its god-ordained profits.

I had my first dose today and have had a splitting headache for hours. That's odd, because I almost never get headaches. But now, I have a whole new body chemistry! Yay!

[cross-posted at NPR Check]

If you watch or listen to Democracy Now! you know about the latest study on insurance and mortality in US adults. It's no big deal, just some wacky research indicating that tens of thousands of people (45,000 actually) in the US die every year because they don't have health insurance.

Reuters has a run down on all the ways the proposed legislation will undermine the employer provided system.

When people say they like their health insurance, what they really mean is they like getting their insurance through their employer who pays most of the premium. They won't like paying for 100% of the premium, especially if they have a family to provide for.

If we are not going to replace the employer provider system with HR 676, then we need to strengthen, not weaken it.

Salt Lake City Tribune:

Five days on the road, and a group of physicians from Washington, Oregon and Arizona are truly mad as hell about the nation's health-care system and the way the reform debate has shaped up.

Especially infuriating, the self-named Mad as Hell doctors said during a town-hall meeting at the Salt Lake City Library on Saturday, is President Barack Obama's apparent dismissal of a single-payer system which they say would insure every American and cost the least.

Even Obama's Wednesday night health-care speech was nothing more than "a Band-aid clinging to the edges of a gaping, stinking wound," said Salt Lake City attorney-physician Clark Newhall, whose stemwinder call to action prompted a crowd of 75 to shout out their disapproval.

"Health care is a right," Newhall cried. "We have a moral obligation to take care of our fellow citizens. Everybody in! Nobody out!"...

The traveling Mad as Hell Doctors -- Katharine Ottaway from Port Townsend, Wash.; Paul Hochfeld, of Corvallis, Ore; Joe Eusterman, of Wilsonville, Ore.; and Tim Jordan, of Phoenix -- are just as angry as Beale, and with other physicians have filed a formal request to meet with Obama sometime after they arrive in Washington on Oct. 1.

They want to talk about one thing: single-payer health care. The president has yet to respond, the group said.

Starting in Portland, Ore., on Monday, the doctors have traveled in a rented recreational vehicle throughout the northwest to Salt Lake City. They will travel on to at least 15 more cities before mustering with anyone who wants to join them in Gettysburg, Pa.

Well, my only question is how Rahm will respond:

I pray the progressives wake up soon and come out of their collective slumber before we help the Democrats pass a health insurance bail out. The reforms championed two years ago, that rested largely on providing Americans with a Medicare-like plan, open to all takers, has morphed into Romney Care. While the centerpiece progressives envisioned on health care reform rested largely on federal intervention via program, the Democrats have cleary gone the less contentious route of a federal roll via regulation. The idea seems to be create a federal role, and hopefully tighten regulations later down the road, which is laughable.

In Obama's recent speech, he equated the movement to extend Medicare to all Americans with the Canadian single-payer.

There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada’s where we would severely restrict the private insurance market and have the government provide coverage for everyone.” ...such a plan “would represent a radical shift that would disrupt the health care most people currently have.

He also reminded his "progressive friends" what apparently the real driving force behind health reform has been about all these years:

Martha Burk:

Dammit President Obama -- we support you. Women put you in office, and stuck with you when the crazies were beating you up with "death panels" and "socialized medicine."

We still support you, but like millions of women who were watching, we wonder why you have to always use our most intimate health issues as a bargaining chip to give away, when you're not going to get anything back. You did it at Notre Dame, and now you've done it again.

For the so-called "public option" (or "plan") to work, the insurance companies must be tightly and successfully regulated, as its advocates will admit. This is true for several reasons: First, so they don't sell junk insurance to the people who will be forced to buy it via the mandate; so they don't deny coverage to those who have paid their premiums via scams like rescission; so they don't cherrypick those who are less likely to need insurance, throwing the rest of the burden on taxpayers; and finally, so they "play fair"* as contractors, when they manage and administer the "public plan" (or "option") for the government.**

Will tightly regulating the insurance companies work? Fortunately, we have a controlled experiment we can look at that compares single payer and the privatized approach directly: Medicare, and Medicare Part D. Don McCann writes at PNHP:

What’s beautiful about the Medicare Advantage program is that it has provided us with a real-life laboratory experiment which allows us to compare the functioning of highly-regulated private insurance plans as contrasted with the functioning of a public insurance program: traditional Medicare. The results are in, though that would be tough to ascertain if you simply observe the response of Congress.

What have we learned? The private plans take away the choice of health care providers that the traditional public program offers. The private plans insert intrusive interventions between the patient and the physician – interventions that are not found in the public plans. Private plans divert more resources to excessive, wasteful administrative services while increasing the administrative burden on the health care providers and on the public stewards who must provide oversight of our tax dollars that are diverted to this industry. Private plans also provide more entry points for the criminal element to cheat the taxpayers, patients, and providers. And for this we are paying far more of our tax dollars than we do in the traditional Medicare program for comparable levels of care. ... Our Medicare Advantage experiment has demonstrated that it is the private plans that must be jettisoned, and it is Medicare that must be granted to everyone after modest, appropriate reengineering so that it works even better than it does now.

In an Op-Ed for Washington Times, no less. Here's the description:

One little-noticed proposal has attracted an ideologically breathtaking span of senators and seems to have been unjustly overlooked in the debate: the Healthy Americans Act, sponsored by liberal Democratic Sen. Ron Wyden of Oregon and conservative Republican Sen. Robert F. Bennett of Utah. The amazing list of 15 co-sponsors includes eight Democrats, from Bill Nelson of Florida to Maria Cantwell of Washington, and seven Republicans, from Bob Corker of Tennessee to Charles E. Grassley of Iowa.

I had heard about this bill but never took the time to look it up and research it. How is it possible we know so little about it? And why hasn't Mr. Obama invited these 15 senators to the White House to have them explain it better? Maybe he should before his speech Wednesday.

The basic idea of the proposal is, in effect, to "liquefy" everyone's current employer-provided health insurance policies -- i.e., require all employers to pay in cash to each employee the actual cost of that individual's insurance policy, and that extra compensation would have to be used by each employee to purchase health insurance policies. All those receiving this boost in pay would receive a tax deduction, varying in amount according to their income -- i.e., you get some or all of the tax deduction the employer currently gets for paying your insurance.

So, it's another backdoor way to get rid of the employer exclusion, yes?

Times:

In a last effort to give the Senate a bipartisan health care bill, the chairman of the Senate Finance Committee circulated a comprehensive proposal on Sunday to overhaul the health care system and proposed a new fee on insurance companies to help pay for coverage of the uninsured.

Mr. Schumer said, “The health insurance industry should pay its fair share of the cost because it stands to gain over 40 million new consumers under health care* reform legislation.”

Translation: We bailed you out with the mandate. Now, give a cut to the uninsured with this fee.

Of course, the insurance companies will immediately pass the fee on to their existing policy holders:

[cross posted at NPR Check]

Fox News makes no bones about endorsing the extreme-right, proud-to-be-stupid Tea Party Express, but NPR is a bit more subtle in its pro-Tea Bagger coverage. Over the last three days it has provided this reactionary tour frequent, uncritical broadcasting time:

On Sunday's Weekend Edition Liane Hansen introduces NPR's Jay Brady who is traveling with this road show. In a completely uncritical report Brady makes these statements:

Krugman:

Finally, the third route to universal coverage relies on private insurance companies, using a combination of regulation and subsidies to ensure that everyone is covered. Switzerland offers the clearest example: everyone is required to buy insurance, insurers can’t discriminate based on medical history or pre-existing conditions, and lower-income citizens get government help in paying for their policies.

In this country, the Massachusetts health reform more or less follows the Swiss model; costs are running higher than expected, but the reform has greatly reduced the number of uninsured. And the most common form of health insurance in America, employment-based coverage, actually has some “Swiss” aspects: to avoid making benefits taxable, employers have to follow rules that effectively rule out discrimination based on medical history and subsidize care for lower-wage workers.

And in Massachusetts, where the mandate was another bailout for the insurance companies, compliance is falling because people don't like being forced to buy junk insurance*. Who knew?

So where does Obamacare fit into all this? Basically, it’s a plan to Swissify America, using regulation and subsidies to ensure universal coverage.

Look, I admire the hell out of Krugman for filling the messaging void, here, but shouldn't somebody in the administration or the Congressional leadership be pointing this out?

If we were starting from scratch [Now, where have I heard that before?] we probably wouldn’t have chosen this route. True “socialized medicine” would undoubtedly cost less, and a straightforward extension of Medicare-type coverage to all Americans would probably be cheaper than a Swiss-style system. That’s why I and others believe that a true public option competing with private insurers is extremely important: otherwise, rising costs could all too easily undermine the whole effort.

But a Swiss-style system of universal coverage would be a vast improvement on what we have now. And we already know that such systems work.

So we can do this. At this point, all that stands in the way of universal health care in America are the greed of the medical-industrial complex, the lies of the right-wing propaganda machine, and the gullibility of voters who believe those lies.

Really?

Times:

President Obama has made health care his top priority. He says the cost of Medicare and Medicaid is “the biggest threat” to the nation’s fiscal future. But to the puzzlement of Congress and health care experts around the country, Mr. Obama has not named anyone to lead the agency that runs the two giant programs.

The agency, the Centers for Medicare and Medicaid Services, is the largest buyer of health care in the United States. Its programs are at the heart of efforts to overhaul the health care system. If it had an administrator, that person would be working with Congress on legislation and could be preparing the agency for a new, expanded role.

So, Obama doesn't want a Medicare/Medicaid administrator working with Congress then, right? I wonder why?

“The vacancy stands out like a sore thumb,” said Dr. Denis A. Cortese, president of the Mayo Clinic, often cited by the White House as a health care model.

“In effect,” Dr. Cortese said, “Medicare is the nation’s largest insurance company. The president and Congress function as the board of directors.

“Under a strong administrator, it could take the lead in making major changes in the health care delivery system, so we’d get better outcomes and better service at lower cost.”

So, Obama doesn't want a Medicare/Medicaid administrator taking the lead in making major changes, right? I wonder why?

Trying to remake the health care system without a Medicare administrator is like fighting a war without a general.

Well, that would depend on how you define the war, wouldn't it?

Go read it all:

The Senate HELP Committee “public option” will be multiple “options,” and these will be run by insurance companies
If my interpretation of Section 3106 is correct – if the Senate HELP Committee’s “option” program is going to be balkanized and run by the nonprofit wing of the insurance industry – then reasonable people have to conclude that the deck is really stacked against the Committee’s “option” program. Even if Section 3106 authorized public employees, not Blue Cross Blue Shield employees, to create the dozens or hundreds of “community health insurance options” called for by Section 3106, the program would fail to pose any challenge to the insurance industry and might even die in the cradle. The health insurance industry has been very difficult to break into since at least the 1980s, and has become more so in the wake of the merger madness that swept through the industry in the early 1990s. But if public employees are not going to be directly responsible for creating the “community options” – if the nonprofit wing of the insurance industry is going to be doing that – then the entire “community option” project of the Senate HELP Committee amounts to a cruel joke on the public. Should the public trust corporations like Blue Cross and Kaiser Permanente to make a good faith effort to build competing insurance companies?

Section 3106 is a mess, but its meaning becomes clear after several readings. Section 3106 does not create the “Medicare-like” program promised by Jacob Hacker, HCAN, Howard Dean, and other “option” advocates. Instead it proposes a program that authorizes DHHS to create numerous health insurance companies tied to geographic areas, and to contract with members of the existing insurance industry to create and possibly run those companies.

Translation: With the mandate, that's a bailout for the insurance companies. And I imagine those contracts are going to be awarded in much the same way as, say, garbage contracts are awarded in Chicago.

The sick, in this case, being the garbage.

You know the old joke, right?

A physicist, a chemist, and an economist are shipwrecked on a desert island. Starving, they find a case of canned pork and beans on the beach, but they have no can opener. So, they hold a symposium on how to open the cans. The physicist goes first:

"I've devised a physical solution. We find a pointed rock and propel it at the lid of the can at, say, 25 meters per second --"

The chemist breaks in:

"No, I have a chemical solution: we heat the molecules of the contents to over 100 degrees Centigrade until the pressure builds to --"

The economist interrupts:

"Gentlemen, gentlemen, I have a much more elegant solution. Assume we have a can opener..."

Via Digby, Krugman:

Health Reform Made Simple
Individual mandates are a way to prevent gaming of the system by
people who don’t sign up until they’re sick; employer mandates a way to hold down the on-budget costs by preventing a rush by employers to drop insurance; the public option a way to create effective competition and hold costs down further. ...

But what it means for the individual will be that insurers can’t reject you, and if your income is relatively low, the government will help pay your premiums. ...

That’s it. Any commentator who whines [Atrios a whiner? Not.] that he just doesn’t understand it is basically saying that he doesn’t want to understand it.

Nope. In this case, Professor Krugman is asking me to assume not a can-opener, but a Health Exchange. Can anybody point me to one of these Health Insurance eXchanges that actually works?*

Thanks, Max!

Ian Welsh, who's been on fire lately:

I’ll settle for a good public option, or even a non-sucky one. But I’m becoming convinced that any public option will either be too compromised, or non existent, and at that point, all that happens is you have slashes to Medicare and Medicaid, forced purchase of bad insurance, and through those purchases more money being pumped into the system.

As I've said in the context of the bailout for banksters: If you pump more blood into a zombie, it's still a zombie.

Is forcing people to buy insurance the real goal? The best way to make money, bar none, is to have government force people to buy your product. It’s a wet dream for any industry, so if it’s going to be done, it has to be done right—it has to be very highly regulated and controlled with rates of return set like utilities.

Will it be?

Simple answers to simple questions:

Capital Press

LINCOLN, Neb. (AP) - A new report says farmers and ranchers often can't afford the health insurance offered to small-business owners.

The report from The Access Project says family farmers and ranchers are insured at a rate higher than the general population, but that 10 percent of them were uninsured, or had an uninsured family member, sometime during the previous year.

The report was based on data gathered through a 2007 survey of farm and ranch operators in seven Great Plains states including Nebraska, South Dakota and North Dakota.

Pa. House sends health insurance bill to Senate

HARRISBURG - A bill to open Pennsylvania's government-subsidized health-insurance program to 85,000 more lower-income adults won House approval yesterday.

But the chances of this bill reaching Gov. Rendell's desk appear bleak.

While passage had been a priority of House Democrats, who symbolically numbered it House Bill 1, only a single Republican representative crossed party lines in the 104-96 vote.

Sign the open letter from PNHP to Obama demanding that Obama follow through on his 2003 promise to support single payer:

Single payer reform, as embodied in these bills, would eliminate the bewildering patchwork of private insurance plans with their exorbitant overhead and profits, as well as the costly paperwork burdens they impose on providers. These savings on bureaucracy - nearly $400 billion annually – are sufficient to cover all of the uninsured and to provide first dollar coverage for all Americans. No other approach can provide comparable coverage at a cost our nation can afford.

Mr. President, you once embraced a single payer reform that would threaten private insurers, and foresaw its passage if Democrats regained control of the House, the Senate and the White House. These conditions have been met. Yet now Democrats propose diverting additional billions to private insurers by requiring middle class Americans to purchase defective policies from these firms – policies with so many gaps and loopholes that they currently leave millions of our insured patients vulnerable to financial ruin.

Way to negotiate the deal, there, John.* HuffPo:

In a closed-door meeting of Senate Finance Committee Democratic members and their staff Wednesday evening, Sen. John Kerry (D-Mass.) suggested that if the committee bill didn't have enough votes for a public option it include a ten-year delay [FAIL!] between passage of health care reform and the implementation of a public option that Americans could buy into, according to two Democratic aides.

So, we'll put off real reform 10 years just to pass a meaningful bill? I am s-o-o-o-o glad we have more Democrats!!!!!!!