The President: "Would you feel the same way if you were making $40,000...? Because that's the reality for a lot of folks. I mean, it is very important for us ... to listen to the folks that we get letters from -- because the truth of the matter, John, is they're not premiers of anyplace, they're not sultans from wherever. They don't fly into Mayo and suddenly decide they're going to spend a couple million dollars on the absolute, best health care. They're folks who are left out." (President Obama at the recent health care summit)
President Obama's statement perfectly encapsulates why I and many others are Democrats - our commitment to our fellow citizens who lack the resources to protect their families from misfortune. Sadly, I believe if we apply that standard to the proposed health care legislation, a Democrat should oppose this bill. Though superficially attractive, the bill's benefits to the uninsured are likely to be temporary, while its costs - even to its beneficiaries - will be large and lasting.
We Democrats have been swept up in a straightforward narrative of health care reform. For almost seventy years, we've been fighting entrenched industry interests to provide universal access to care - a benefit enjoyed by the citizens of all other developed countries. In the Administration's formulation, we're -- finally -- on the brink of a historic victory.
However, as with many long wars, we the combatants have ignored the transformation of the landscape - a transformation that has rendered our initial goals and our methods for achieving them hopelessly outdated.
First, over those 70 years health care has evolved from a rarely utilized service to the largest industry in our economy, as our physical and emotional well-being has become increasingly medicalized. The share of resources now devoted to care has impeded growth in our standard of living, especially for our middle class. Everyone knows that the US spends an astounding 17% of our GDP on care; but how many realize that over the past five years, we've spent 28 cents of every dollar of income growth? Our government's existing health care obligations account for much of America's deteriorating fiscal prospects, with all its negative implications for our future well-being.
Second, there is extensive evidence that the poorly structured incentives of our insurance-based system are themselves the cause of our health care inflation. Yet, continuing our Party's almost unquestioned conflation of health insurance with health care, the central feature of the proposed "reform" is further extension of our flawed insurance-based system.
Third, every other developed country is struggling with the cost of its universal health care system to such a degree that fundamental reform will almost certainly prove necessary to insure long-term sustainability. It is true that the US spends far more on health care than the universal care countries today; but it is absurd for us to ignore the lessons of the high rate of cost growth in these countries - growth that in some cases exceeds our own.
Fourth, despite the Administration's recent heated rhetoric, most of the entrenched health industry interests are quietly or openly in favor of this bill. Should the bill become law, I suspect we will look back at it as an industry bailout. Why? For the health insurance industry, the legislation not only guarantees tens of millions more customers, but also requires participation by the low-risk young and healthy. For hospitals, the legislation will reduce the cost of providing low-compensated care, by turning currently uninsured customers into full-paying private insurance ones.
But even if the health care landscape has shifted, doesn't the promise of adding 30 million uninsureds to the insurance safety net make the bill worthy of Democratic support? Only if we insist on looking at health care as an island, separate from everything else affecting American families. How else can Democrats in the depths of a recession support a massive tax increase on middle-class job creation (which is the effect of a corporate mandate)? How else could we justify diverting even more of middle class income to support our broken system of care, further starving families of funds for all their other needs? Most uninsured Americans lack insurance only temporarily; how many of them would trade lesser lifetime job prospects and lower disposable income for the short-term retention of health insurance?
Despite the bill's new subsidies to those who can' t afford whatever health insurance Congress deems to be adequate, the additional health spending in this bill heavily rests on private money - specifically the money of the currently uninsured who will be required to buy insurance. With health care now so expensive, the Government can't afford to fund the premiums for the ever-growing number of the uninsured. So it's requiring them - those $40,000 a year families - to share the costs.
The bill's subsidies may well provide some affordability benefit - but without meaningful reductions in the price of care, these are likely to be only temporary salve. How? Look at Medicare's history; its lack of real financial discipline has helped drive up care costs, leading to ever-greater premiums and out-of-pocket paid by its beneficiaries. So even with the government paying almost all of their bills, today's seniors pay a higher share of their income for health care than seniors did before Medicare.
Our current system of financing health care is also extraordinarily regressive - and the bill's mandate will make it even more regressive. Surprised? Consider corporate funded health insurance; the $15,000 annual premium for family coverage is a small share of the cost of compensation for the CEO, but a massive share of the compensation cost for the $40,000 a year employee. The Administration's own economists admit the obvious: regardless of who writes the premium check, it's the employee who's really funding the entire cost. Tack on Medicare taxes and out-of-pocket expenses, and the $40,000 a year employee is bearing health costs equal to 30% of his true cost to his employer; does this seem like a progressive system of funding worthy of extension?
For all the traditional liberal support for Medicare, even this cornerstone of government health care financing has a regressive effect, transferring resources from younger, poorer Americans to older, more financially secure ones. And the odds of the implicit "generational pact" ever being made good for today's younger people recedes daily; Medicare now has $74 trillion of unfunded liabilities, which this "reform" does nothing to fix.
And for the least well-off Americans? Expanding the eligibility for Medicaid may make legislators feel better, but with doctors abandoning the program, does this approach seem like a sustainable solution for their care needs?
The President is right that reform is urgent, but it must be real fundamental reform that alters the underlying structural incentives driving excessive health spending and prices. The true emergency is the growth of health care spending, which last year alone rose at a rate 6% above the rate of general inflation. Trying to control the cost of health insurance without meaningfully changing the incentives in health care is like trying to control gas prices by focusing on gas stations instead of oil markets. Yet without effective action against galloping care price increases, it will prove impossible for our nation to sustain real health security to our citizens.
For all its hat-tipping to cost control ideas, the legislation does little to curb health inflation. Its most important source of savings is $500 billion of unspecified Medicare cuts. If these savings should somehow be realized, shouldn't they be used to prop up this functionally insolvent program, rather than "fund" a new subsidy? Of course, does anyone expect these savings to be realized, when the same Congress debating their inclusion was also debating how - not whether - to repeal $250 billion of previously legislated Medicare cuts? If the legislation had any real prospect of controlling health care spending, would the pharmaceutical industry be funding the "yes" campaign?
We Democrats should not be requiring the middle class to spend ever more of their declining wealth on health care until we address the issue of why the $2.5 trillion we're already spending isn't sufficient. Does anyone doubt that the excess care, administrative waste, and undisciplined pricing in our current spending alone could fund all needed care for those now without it?
And while the anecdotes of Americans suffering without access to essential care tug at our heart-strings, remember that the accounting trick at the core of this legislation ("balancing" ten years of revenue and six years of benefits to produce "deficit neutral" results) means it will be four years before any additional Americans would be added to the insurance rolls. We have time to get this right.
What about the argument that Democrats should take what we can get now, in the knowledge that the bill's many failings can be fixed later? As the above makes clear, I'm not certain that what we are "getting now" is actually a positive for many uninsured Americans. Further, the bill will cement the inefficiencies and unaccountable practices in the health industries through yet more health spending; so it will be even politically harder later to get agreement on fixes, much less real reform.
The Republican Party's approach to health reform has been so hypocritical and obstructionist that it borders on the unpatriotic; all Democrats would like to see our well-meaning Administration have a political boost at the expense of a cynical opposition. But that win is likely to be achieved at real cost to many Americans - including many families getting by on $40,000 a year. We need to take the President at his word: this should be about doing what's right not what's political. With a very heavy heart, this Democrat suggests a "no" vote.
Over the past year, one plan offered was to force our elected officials to suffer with the same health insurance as the rest of us. Government employees choose and pay for a variety of policies under control of the government to stay accountable and made affordable by enrolling many in a joint plan with massive force of numbers. They are much like the Public Option Plan that was forbidden to us by the powers-that-be.
Why not turn that idea around?
Why can we not join our privileged House, Senate and administration and simply pay our own way by having access to the same policies available to them? Add everyone with Mandates? Even more policy-holders than Washington can supply on their own. Imagine how the cost will drop, even for those legislators that were never taught to share. Distruptive? The plan is already up and running, probably with the same companies that have their hooks in us now. We have been denied Single-Payer, we have been denied Robust Public Option, we have been denied Medicare Buy-In as too disruptive, too expensive. Who among our leaders would dare refuse a bill that would bring down costs and reward everyone?
(except for those belonging to the insurance companies.) Oh yeah, that.â€â€
The public option is incredibly popular until you begin to hash out the details of how it will be structured and operate. I suspect it will drop in popularity--rates will be too high, reimbursement too high or too low, too few eligible, rate increases, etc.
This bill does some very important insurance reforms. The day it's signed into law children can no longer be denied coverage for pre-existing conditions. You're saying that that is not important? Setting up exchanges so people can pool their resources to purchase insurance does reduce cost per individual. People like to hold up the public option as the way to best reduce cost, but that isn't a guarenteed fix. Medicare has a relatively low cost because their reimbursement rates to providers are rather low--in cases of rural states too low ( rural areas don't have the volume to overcome expenses, that a UCLA Med would have). The cost to buy into a public option would higher than most people would expect. And there's also the question of rate increases. Either the public option is deficit neutral in which case rises in overall health care costs would necessitate rate increases, or it would be entirely deficit funded and would be unsustainable.
That is important, but as I recall, didn't a Republican call that a "no-brainer" in the summit? In other words, couldn't that goal be achieved with a two or three page bill that would, obviously, receive broad appeal, and be written, discussed, approved and signed in a matter of days?
Wasn't the point of all this HCR debate and battle to provide "universal" care to help those who could not afford insurace - so-called "public option".
Instead, we have no public option, millions of new mandated customers for the "evil" insurance industry that we're told is to blame for the high costs.
Other than wanting to chalk up a "win" in DC, what about the existing bill is what Dems actually wanted?
It would seem to be little - hence the Speaker's inability to get a majority to vote for it despite owning a 75 vote majority in the House.
1. Close the donut hole. Major positive.
2. End the ability of insurance companies to deny coverage when you need it. Major positive.
3. Allow children to stay on their parent's policies until age 26. Major positive for students.
4. Insure 31 million people; provide vouchers for those who economically need it. Major positive.
5. And oh, just to throw it in, a huge positive -- get banks out of the student loan business so that more students can get loans. Rather than have banks making enormous profits on students.
My guess is that most people opposed to this bill now have insurance. Would LOVE to see polls on this figure... what percentage of people who don't have insurance now are opposed to this bill?
I have students who are ill -- who need medical attention now -- and don't get it. And they will eventually end up in the emergency room, causing us more money in the long run. And pain for themselves and their families. Twice in the last month, I've asked them, "Why don't you get that taken care of? It looks like you're really hurting." Answer: I don't have insurance. That's a person with kidney stones, tremendously painful. Can't afford the procedure. And a person with a bladder infection. That could get much much worse. Can't afford a doctor.
That's the real world that needs to be fixed. Not just inside the beltway.
Let's see if this passes moderation.
Social Security, Civil Rights, Medicare. These were sweeping changes brought about by legislation, but they all had broad support in the country and bipartisan support in the government. That was necessary because of the strong opposition on these topics.
Now we have a major sweeping change that a majority of Americans are saying, "slow down." We have zero support from the Republicans, and the arm twisting is from the majority party on their own party.
This is unprecedented.
82 Democrats votes "Yes" on Iraq. The public was for Iraq in overwhelming numbers.
The Civil Rights Act of 1964, 80% of Republicans and 63% of Democrats voted for it.
The Senate version, voted on by the House:
Democratic Party: 153-91 (63%-37%)
Republican Party: 136-35 (80%-20%)
If this bill is the right thing to do, get at least a majority of Americans convinced it is. If it is the right thing to do, it shouldn't be hard to get a few Republican votes from the very moderate.
This is unpopular and it is wrong to push it on everyone with out any consenseus.
This is wrong at a level that has never been done in Washington. Slow down and convince the American people that this is the right bill.
There have been countless times in American history when leaders have actually LED us forward... to end slavery and to allow blacks to vote -- neither of which were popular. To end desegregation in the armed forces -- which wasn't popular. And I don't know the poll numbers, but I'd suspect Social Security and Medicare would not have polled as well as you so blithely suggest. [Cue Reagan's hysterical rant against Medicare associalist evil.]
Your entire post is so Clintonian... follow the polls and triangulate.... it makes me sick.
And, moreover, the media provides so much misinformation that the poll numbers are skewed by our collective ignorance. Most Americans are misinformed. We poll people who don't know what they're talking about. But let's poll them some more anyways. Delay. Misinform. Delay. Misinform. Delay. Rethug strategy.
Repubicans 81 yes 21 no
Democrats 284 yes 15 no
Vote Tallies for Passage of Medicare in 1965
Repubicans 237 yes 48 no
Democrats 70 yes 68 no
Americans are engaged on this issue. They as a whole are not misinformed. I am not saying that government should be run by polls, but a sweeping change to what is America should be done with some consenseus. There isn't one vote from a Republican. No major piece of legislation has been done this way.
I understand your desire to win, but this will not get you what you want. You seem to be willful ignoring what is going on outside HP.
Seriously, the Republican party is adamantly opposed to any type of reform. Their only position is to do nothing. They'll throw out criticisms or claim they have better ideas, yet at no point during the Bush administration did any Republican act on those ideas. Right now they tout lies about death panels killing grandma, make claims that this is a government takeover of health care ( it's not which is why liberals are unhappy with this bill). They spread lies to torpedo this effort.
To be fair the Dems haven't done a good job of talking up the bill. But the media also refuses to do any indepth coverage of this. Instead you get two people yelling at one another instead of a debate.
What you have now is one party that wants to get things done, and the other that wants to do absolutely nothing so they can win in 2010. There's 0 common ground and 0 chance of bipartisanship.
If you don't get consenseous, the Democrats look like bullies and the Republicans look like heros. If you are right about this legislation, they will look like fools, but only if you can make a convincing argument as to why.
That hasn't been done.
The Democrat purist who demands rightness of thought and action. The McGovernite (and I truly respected the man, volunteered for him). The one who cares more fighting the good fight than actually getting something done down in the dirty political trenches.
For me, the wait has been way way way too long. Clinton tried to do it all at once. That didn't work. And it cost us 15 years and, in the real world, real pain, real deaths. Time to take a step forward, people. Not as big a step as I'd like. But a step. Get this done and then improve.
yes, president obama is proving himself to be A TOADY to his radical Righ-Wing, pro-wars, pro-DEREGULATION of financial markets ("the better to LOOT the peons & serfs, my dear"), PRO BAILOUTS, pro NO OVERSIGHT of bailouts, Economic-Hit-Man Rasputin of a chief of staff, rahm emanuel.
this so-called "reform" bill is a MONUMENT to DECEIT, SABOTAGE, TREACHERY, mass-media propaganda, and EXTORTION of hapless Amerian consumers & taxpayers.
I'd like to add that in addition to the actual reasons you outline above, there are electoral reasons to oppose this bill. Who are these $40,000 dollar families going to blame when they realize "health care reform" is actually a giant new tax they can't afford?
Even the most liberal Democrats out there, like Michael Moore, oppose the language of this bill.
Healthcare reform is necessary. Legal theft as mandated in this bill is ludicrous.
Mr. Goldhill may not be an ideological soulmate, but his arguments against this legislation are right on the mark. It is going to fail, and he's telling us exactly why.
The Democratic Party is now falling ill with the same sickness that has plagued the Republican Party for nearly 20 years. We must not put loyalty to our "team" ahead of loyalty to our country, or we're all doomed.
Americans first. Democrats second.
it's interesting that all those who urge "yes" do so with vague hopes and cliches: "if we don't do this now, we never will;" "we can't let this be a 'loss' for Obama."
No one sits down and READS THE BILL. Mandates? How's THAT gonna work for everyone, especially with no cost controls [no public option]? How are those who previously voted for Democrats going to feel when the IRS comes after them for not purchasing the insurance they can't afford and that doesn't provide quality coverage?
Why are elements like the anti-trust exemption for insurance companies, the ban on re-importation of drugs, the ban on Medicaid et al. bargaining for lower drug prices NOT in the bill?
Why is the provision extending the patent protection to drug companies, so they can block generics [particularly cancer drugs] in the bill?
Proponents of this give-away are arguing based on "hope" and a prayer. Drug manufacturers and insurance companies will eat us alive, and will only get stronger with those mandated premiums. Do you think with their fattened coffers they're going to let those "fixes" make it through the next legislative session?
Oh, and the "benefits" don't start until 2014, which the mandates take effect immediately.
This bill is a set-back for REAL reform of health CARE, not a "first step" that can be fixed later. [BTW, how's that "fix it later" deal working out with respect to FISA, the Patriot Act and NAFTA?]
Them that got coverage don't want others to get it.
Them that make mucho deniro can afford it now.
They don't care about anybody else.
People can be persuaded to go against their best interests by shrill media entertainers.