There's no point just blaming Max Baucus, Rahm Emanuel, or Barack Obama for the current unpleasant state of health reform - although they've each earned their share of criticism. The Left bears some responsibility, too, for failing to set the stage for meaningful change. By granting too much authority to "experts" and ceding their judgment to the resulting groupthink, many progressives laid the groundwork for the poor state of health reform today.
The public option's in trouble. And if Max Baucus and the other centrist Dems have their way Americans will be forced to buy health insurance that costs $12-14,000 per year. Progressives are finally raising a hue and cry about this burden, but a year ago they were busy promoting the idea that mandates were the centerpiece to meaningful health reform. Now, as the reality of this "reform" takes shape, it's becoming clear how badly this could turn out. Rational options are being proposed. But with the mandate issue all but resolved politically, progressives have no leverage left to push their agenda.
I can't have been the only one beating the drum about mandates (although it felt like a lonely position at times). It was clear long ago that any plan that imposes them on the American public without first creating significant savings would be a disaster, both politically and in human terms. As things stand now, a family of four without employer coverage trying to get by on $75,000 could suddenly be forced to fork over 20% of their income to a health insurer - or face government punishment.
And according to the usually-reliable firm Martin E. Segal, those costs are likely to rise more than 10% on average in the coming year, even as benefits are cut back. Mandates? To buy that?
So perhaps those of us who have been sounding the alarm may be forgiven a little frustration when we read items like this one from Josh Marshall, which asks:
Am I the only one who thinks that if the Dems pass a bill with mandates and subsidies for poor and moderate income people to purchase it but no public option or competition with the insurers, that it will be pretty much a catastrophe for the Democrats in political terms?
His reaction's being echoed all over the progressive blogosphere, as progressives suddenly realize the idea's unfair - and a political loser. Jed Lewison at DailyKos called it "horrible political miscalculation" when Marc Ambinder reported that "the President continues to operate under the belief that liberals will warm to the bill when presented with a goodybag that includes an individual mandate ... "
How? How could the president get the idea that an individual mandate, especially without a public option, was a "goody" for progressives?
Because progressives told him so - over and over during the 2008 primaries. Supporters of John Edwards and then Hillary Clinton hammered Obama because his plan didn't include individual mandates, claiming explicitly (and wrongly) that mandates equaled "universal coverage" and were therefore more "left." And it's still happening, as in Joan Walsh's comment from a recent piece:
Let's remember that Obama opposed mandatory universal health insurance and backed the GOP fiction about the need for social security reform' - two social policy stands that put him to the right of all the leading Democrats in the primaries.
No! "Mandatory universal health insurance" is not a progressive position, as we explained here in 2007. And it's not even "universal," as we explained in early 2008. That's why Obama was able to score some points against his opponents in the primaries by rejecting mandates. That's a pledge he broke early on without drawing liberal fire, perhaps because of progressive misconceptions about this policy. But Paul Krugman, who battered Obama on this point during the election, understands what a wildfire the Democrats will ignite if they push mandates without a public option.
Context is everything. Virtually without exception, writers who are considered progressive leaders on health care pushed for individual mandates without considering the regressive and confiscatory form they could well take, and without emphasizing that they could only work fairly in the right context. As Ezra Klein wrote when the president met with all those "stakeholders," reflecting this progressive consensus: "Insurance market reforms can't happen in the absence of an individual mandate. Either everyone jumps together or no one will leave the ledge."
There is sound actuarial logic and economic calculation behind this concept. But a kind of groupthink took over. The group-thinkers decided to push Obama on mandates and assume that questions of access, fairness, and cost containment will be handled through a public option or some other mechanism. But nobody put those issues on the front burner, even though they were given lip service. The result is the potentially disastrous plan facing us today.
With mandates, the execution has to be practical and fair. Taxation's one such principle - the one I originally pushed - but it's apparently politically unsupportable. So Jacob Hacker came up with another (as discussed in my interview with him, here). But Hacker's plan, as with any meaningful reform proposal, requires a public option - both for cost containment and to serve as an insurer of last resort. If you're going to force people to buy something, you have to ensure they can afford it.
How did we get here? Josh Marshall's piece holds part of the answer. First he writes of Switzerland and Massachusetts, whose plans feature individual mandates and no public plan. But Switzerland created a rational system before things got out of control, so the Swiss aren't being forced to buy $14,000 plans. As for Massachusetts, its reform is only vaguely popular there, where the initial problems weren't nearly as complex as they are nationally, and is decidedly unpopular with those who have been affected by it (see summary about two-thirds of the way down the page, here).
And I have a sneaking suspicion that the people affected on the national level - independent tradespeople and contractors, for example - might just be swing voters in critical states like Indiana.
Marshall writes: "... many health care experts I have a lot of respect for still believe (these plans) would be a big improvement over the current situation." I have respect for those people, too, but we might be better off today if Josh Marshall and others had trusted their own instincts instead of relying on a group of people who appear to have reinforced each others' fixation on mandates. Now the progressive debate has been reduced to whether the likely final version (via Sen. Baucus) will be slightly better or significantly worse than today's status quo - and sadly, we can't know the answer to even that modest question yet. We could have had better than this.
So what now? Let's encourage the people who spoke with one voice in favor of mandates to speak with one voice again - this time, in favor of comprehensive and meaningful reform - while there's still a chance to influence this legislation.
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RJ Eskow blogs when he can at:
A Night Light
The Sentinel Effect: Healthcare Blog
Follow RJ Eskow on Twitter: www.twitter.com/rjeskow
If everyone is required to buy insurance, there has to be a 'safety valve' option that is not a private for-profit company.
Otherwise, it will properly be seen as a give-away to a Private Insurance and nothing more.
Even if reform tries to clean up Big Insurance until their fleece is whiter than snow--if they are the only option for buying insurance then it's voters who will be taking a bath. And Democrats who will suffer.
There HAS to be a public--or non-profit and low-cost--option.
UNDER OBAMA'S nEw plan, the uninsured will be FORCED UNDER PENALTY OF LAW to purchase insurance from one of the Health Insurance Companies that have spent the last few decades ripping them off and dropping their coverage whenever they actually need the insurance..
Should you NOT buy a plan from one of these Insurance Companies, you will be fined by the IRS, which if you cannot pay the fine, ADDS PENALTIES every year, so your fine will continue to grow.
The above scheme, is WHY the health insurance companies, drug manufacturers, and other profiteers are now said to be ''ON BOARD'' Obamas plan- whatever they lose through policy-sharking ON COST, THEY WILL MAKE UP in VOLUME, as every citizen is now compelled through IRS enforcement action to become the customers of the most corrupt, despicable, and untrustworthy of all business ventures..
OBAMA, LAST NIGHT, WAS WILLING TO DEMAND MANDATES AGAINST INDIVIDUAL PRIVATE CITIZENS, BUT HE WAS NOT WILLING TO DEMAND A REQUIREMENT FOR A PUBLIC OPTION. Ensuring more customers for corrupt insurance companies who ARE THE SOURCE OF THE PROBLEM in the first place is not reform. It is either capitulation, surrender, or complicity
Pass oversight, but their can be NO MANDATE and their MUST BE A PUBLIC OPTION to allow a escape from the corrupt insurance companies for those who want it...
those two non-negotiables are the two things Obama imediately sold-out on
However, without a public option to contain costs, the insurance companies will have us at their mercy. With auto insurance, we have dozens - possibly hundreds - of companies to choose from, so we can get competitive rates. But, if we live in an area that has one or two health insurance companies, mandates will mean they can charge whatever they want.
Young voters - a big part of the democratic base - will be outraged. They generally can't afford health insurance and generally don't use it much. They would be the profitable new customers for the insurance companies, but they will be livid and rebellious at the idea. Do Democrats think the nations 20 somethings are so docile that they will suck it up and keep voting for them? Or, are they calculating that 20 somethings vote at such low levels that they will be over it by the time they reach 30?
Never ever ever give up!!! Folks, do not forget the marches on September 13th!!! http://marchforhealthcare.com/events/
If not now, when? If not us, who?
Kennedy was one of our greatest champions of health care reform. He carried the torch for a long time...and now it is up to us to continue to carry it!
Our elected officials in Congress receive health care mostly paid for by us tax payers, yet many are trying to make it impossible for us to purchase an affordable plan of our own :
While many of us are struggling to afford medical insurance/medical bills.
While Congress people try to stop healthcare reform.
While Congress people accept large contributions from lobbyists to prevent health care reform.
Please sign these petitions - and by all means, spread the word! Thank you!
http://www.petitiononline.com/PubOp676/petition.html
http://www.democrats.com/honor-ted-kennedy?cid=ZGVtczQ0MTA5OGRlbXM=
http://salsa.wiredforchange.com/o/5649/t/4922/content.jsp?content_KEY=2763&tag=hk1_typ-e1
"Let me say this about that" J.F.K.
Congratulations President Obama! Your outline of what you propose could not have been made more clear, and can only help everyone in America. To those that still oppose this progressive approach I can only say. " Oh ye of little faith", and I'll add "little charity".
To Rush, Beck and the like who only care about their ratings, I say, "You are nothing compared to the President of the United States" who's only true goal is for the betterment, and to do right for all the American people.
The only way to get to universal coverage is with a single payer system funded by some tax scheme other than employment based. A value added tax that would tax imported, as well as domestically produced, goods and services would be the most equitable and would force those imports to share in the cost of healthcare and keep more jobs in the U.S.
But for now, if the Dems do anything, it has to include a strong, credible public option.
This is a policy statement, not a political statement. As a technical matter it may be sound and desirable, but as a policy statement it conflicts with the fact that a number of other countries have achieved universal coverage without single payer (Germany). As a political statement, it is problematic because there isn't the political will to reorganize 17% of the US economy and put it under federal control -- even though in the long run this might be the most cost efficient approach. The political transition costs are just too high, which is why the present outline of reform (reform but keep private insurance -- subsidized insurance for low incomes -- and make private insurance more competitive with the introduction of a "public option" or some other non-profit insurance) was the best chance alternative to single-payer.
I supported his stance over Clinton's for the same reason. This healthcare issue is so multifaceted and most people- progressives included don't get it.
working in the industry over 20 years I can tell you who pays for the program is not even the begining.
We need torte reform, better medical guidelines, better patient teaching and education on health care, Less time covering our butts from lawsuits and more honest conversations with patients. Less wastefullyness with medical supplies and diagnostic tests, Less expensive medical schools so physicans don't have to see 30 patients per day to pay back >100K loans. Control over malpractice insurance-drives physicans out of some parts of the country. Better control over where/when drug companies market. They should not be allowed NEAR resident doctors or teaching hospitals. More patient accountability- understand options and utilize the emergency room appropriately.
Better access and coverage of preventative care. Decreased premiums for private insurance.
These are just a few things I can think of off the top of my head and yet the far left is looking at only one piece of the bill without making sure we get the rest.
If he shows me what I need to see on some of these most important issues I WILL support him.
Having a gov't supplied policy does not help if we don't change the culture of medicine.
HR676 calls for an agency to look into the issues of quality of care that could, and I hope would, bring those issues you bemaon to the fore. I suspect that your malpractice insurance is suffering the same gouging that health insurance premiums are inflicting on us all. Most states have torte limitations already. As for seeing 30 patients a day, based on what I've seen over my life, that amounts to 5 contact hours a day, and you typically work 4 days a week. I don't know how much pre-consulation study you do though, but I think most of it is done on the fly between patients. I also see, almost every time I'm in awaiting room, a drug pusher from big Pharma making their pitch.
My advice is do what we PhDs in the semiconductor industry do - work 12 hour, 5-1/2 day weeks.
Pretty far out thinking, but interesting.....
Barack was a rockin' musician;
But his vanishing tricks
On the public plan fix
Are acts of a Vegas magician.
News Short n' Sweet by JFD8
http://twitter.com/JFD8
Have you been listening to the news lately? It's not going forward due to the huge media coverage being given to lies, half truths and character assassination on a scale that is beyond all rational thinking.
The democrats in congress might not have presented their ideas too well but I wonder if they really want too as they are getting all the cash they want for re-election from the banking and healthcare/industrial complex?
Progressives are working overtime to get this thing passed with a public option so if you want to blame anyone, go after the real culprits, the media and all the rightwing republicans and conservatives who are against ANYTHING Obama wants to pass. And will use any means necessary including the usual fear mongering and lies.
NOT us in the progressive world.
By the way a "centrist" democrat is nothing more than a republican who became a democrat to get elected but still holds basically republican 'values'. DINO
Instead the repubs got the best of the arguement. They reshaped it and got the public opinion behind them.
Let's listen to the president. Find out what you can live with, can't do. and what you're going to support . Then get to working. Nothing will pass withut our support and push. Don't give it to the repubs again.
The president should emphasize the need for a public option in that context. Think about it, people: If you are required to purchase health insurance, do you really think an industry that exists to make a profit will give you a fair deal? Remember, if there's a mandate, everybody else has to buy insurance, too. We'd soon have as many health insurance companies as we had mortgage brokers a couple of years ago, and they would all have one thing in common - the goal of maximizing profit.
Regulations wouldn't control the health insurance industry any better than they did the mortgage/securities industry. Enforcement, and even the continued existence of regulations, would depend on which way the political wind was blowing.
Medicare, on the other hand, has not been so easy to blow over. Republicans have tried. They will try again. But Medicare survives. A public option would have that kind of staying power, and it would provide an alternative to for-profit insurance. If you had to buy insurance, why would you want to eliminate one of your choices, especially the one choice that was created to provide quality, affordable health care? All the other choices were, are, and will be created to make a profit.
A mandate with no public option is absurd.
But I object to Eskow's claim that "progressives" or "progressive groupthink" is somehow to blame for individual mandates in the absence of an open-enrollment public program.
Real progressives supported the candidacy of Dennis Kucinich, and then and now support single payer. Real progressives now and have always insisted on a strong public option as a minimum. And real progressives view the use of public dollars or tax breaks to buy or subsidize private insurance that the government could supply more cheaply, as nothing but the worst form of plutocratic graft, a brazen capital grab by corrupt politicians for the cartel.
Clinton and Edwards and Obama were all Centrist candidates, members of the DLC who voted for the Iraq War, or (in Obama's case would have voted for it, if in the U.S. Senate at the time). Although progressives strongly supported Obama in the general election against McCain, many of us expressed a very realistic assessment of Mr. Obama early in the primary. Many of us warned that Mr. Obama was not what he appeared to be. Certainly none of us supported individual mandates in the absence of a public option that could blow private insurers out of the water.
If they do otherwise, they will pay....
We need to regulate insurance companies like utilities - put in strict price controls and protections. Public utilities seem to be doing just fine.