What about health care reform?

35 thoughts on “What about health care reform?”

1. but the stylistic shift he represents is substantial

   Heh. That pithy little bit pretty much sums it all up.

   Stylistic shifts cannot, by definition, represent substance. And it’s disheartening to hear even smart people fall for the old ‘have a beer with’/’straight shooter’ trap. But in the end, we’re all just the same monkeys we always have been, and beer commercials, lotteries, and resentment-based voting have always worked and always will, so what can you do.

   Of course, I never really liked HCR anyway (despite being the father of someone with a pre-existing condition who will never get health insurance on his own without some reform passing). My issue is mostly with the Democrats’ impotence in principle and the Republican demonstration of absolute, reflexive opposition as an extremely effective political ploy (a lesson that the Democrats will no doubt completely forget when the tide turns, as that is their way). But all that aside, I’m not sure why Democrats and liberal activists are so hung-up on federalizing everything. Look to the states. If you’re sad that HCR didn’t/won’t pass, don’t call your Congressperson. Call your State Congressperson and tell them to set something up in your state. Ask them why they haven’t passed something like the Massachusetts plan in your state. Ask them why people with pre-existing conditions can be excluded from insurance in your state. The US Senate is increasingly nonfunctional as the filibuster is routinized, so ignore it. Stop federalizing everything.Report

   1. “If you’re sad that HCR didn’t/won’t pass, don’t call your Congressperson. Call your State Congressperson and tell them to set something up in your state. Ask them why they haven’t passed something like the Massachusetts plan in your state. Ask them why people with pre-existing conditions can be excluded from insurance in your state. The US Senate is increasingly nonfunctional as the filibuster is routinized, so ignore it. Stop federalizing everything.”

      I’m totally agree with this and have no doubt that quite a few HCR supporters would hear that and be completely dumbfounded by it. For some people, the federal government is the only game in town and as a perception, I think that’s bad for the country.Report

   2. Well I think people give short shrift to style when people are talking about it as a positive thing – but when it is a negative thing, it gets all the weight and gravitas we can muster. Stylistic shifts actually can reflect substance, nor are the two so easily separated.

      That being said, I agree completely with what you’re saying about federalizing everything. Look to the states, indeed. That was the whole point of the American democratic experiment to begin with wasn’t it?Report

      1. Doing health care by states does present some pretty obvious free rider problems.
         Party is state A until you are broken down, then move to state B. States with health care plans run the risk of insuring people who didn’t pay taxes there until they got sick

         There is no other way to say this then: What don’t you understand about the concept of Health Care for All. The liberal vision is that everybody has health care, not just people in NW Americastan or wherever.

         Many states aren’t’ large enough to have a big enough pool to make an effective insurance plan.Report

         1. health care for all through 50 plans isn’t fewer people than health care for all through 1 plan, plus nothing precludes smaller states from banding together. E.D. is talking about possibilities rather than bemoaning the loss of a sixty seat majority and then complaining about the GOP rather than helping some people, you might actually be able to help.

            Also, it isn’t like Massachusetts or Hawaii have been flooded with health insurance free riders…Report

            1. But separate state plans do present a free rider issue, I’m not sure how that can be denied. How big a problem it would be I don’t know, but it seems cavalier just to ignore it.

               Other then the conservative impulse to like Federalism nobody has actually presented a reason why healthcare should be done on a state level. Its just con’s like states and believe modern problems should be solved based on lines created along rivers, random line of longitude and treaties.Report

               1. I’m not ignoring it but countering that objection as a dealbreaker. It stands to measure that the more states that enact plans, the less a factor the free rider problem becomes.

                  Also, there’s a constitutional argument that I believe, that the provision of health care is more properly a state prerogative. For one, the constitutionally suspect mandate would be perfectly legal at the state level.

                  States have differences in demographic composition, so a plan that’s more generous to the elderly might be more necessary in Pennsylvania and Florida than in Maine or Alaska. It’s easier to reform and modify plans at the state level than the federal level, so you’re more likely to get a program that’s adaptive than stagnant.

                  Frankly, I think you could design good state by state programs and a good federal one. It has more to do with the quality of the design than which level you’re designing it for. I just think quite a few liberals seem obsessed with going for federal HCR and won’t even try to do half steps that might actually help people, simply because “they shouldn’t have to” or “grr, evil Republicans” and to me that seems to miss the point. If it’s to help people, then you help the people you can in the ways you can, not fixate over one method and then throw a tantrum when it gets blocked.Report

   3. Let me join the chorus of people who love this comment.Report

2. Do you really believe that the Republican party is going to be reformed from the left? That is daft. Let Scott Brown step out of line just once and he will become a RINO just like Olympia Snowe. These people are running guys like Charlie Crist out of the party and you believe that Scott Brown is going to reform the party? It is not in the interest of the right wing money boys (that is, the boys who make their money off the right wing) to allow any reform of the party, particularly from the left. The only question is whether after they nominate Palin and she gets crushed, whether they will double down with someone more extreme. My money is on that.Report

   1. My hope is not that it will reform from the left or the right – but that it will reform to be less uniform and better represent a wider swath of Americans. Republicans should run more liberal candidates in more liberal states and more conservative candidates in more conservative states. They should be less focused on purity and uniformity and more in line with the idea of decentralization – even in political views.Report

   2. You are right that the opposition movement will not support Brown if he becomes just another statist bozo on the bus. They will turn on him just like they are turning on other statist bozos.Report

   3. “Do you really believe that the Republican party is going to be reformed from the left? That is daft. Let Scott Brown step out of line just once and he will become a RINO just like Olympia Snowe.”

      Speaking for myself at least, I don’t have any haterade for Olympia Snowe, or Susan Collins for that matter. We can have moderates in important positions in the party. For us in the conservative mainstream, we know that we have substantial differences of opinion with both Maine Senators. But that’s what they are. They’ll be with us when they’re with us, and on the other side when they’re not. This is much different from other “moderate” Republican Senators of recent vintage, eg, Arlen Spector, Jim Jeffords or John Chafee. For the most part they viewed themselves as being placed on earth to antagonize the rest of the party, and that’s much harder to work with.Report

3. Sorry, ED, I wish we could have a better Republican party too, but that’s not going to happen as long as Fox News and Limbaugh control the Republican agenda. Scott Brown has little or no chance against that machine (even if he were so inclined).Report

   1. Naah. The troubles we face are institutional architecture which give free rein to obstructive veto groups. Nothing can be accomplished without side deals that turn anything into a rococo mess. Michael Kinsley offered a generation ago that justice and prudence ca. 1984 would have been better served had Mr. Reagan been able to enact his program in full rather than the mix of policies we did get. Kinsley was never an admirer of Reagan.

      As for the Republican caucus at this time, you have two big problems: 1. general vacuity and an orientation toward public policy in the service of producing campaign brochures; and 2. the implication of Republican legislators in the porkscapades. Neither Mr. Limbaugh nor Fox News is the least bit responsible for either.Report

   2. Fox News and Limbaugh are powerful media outlets, but they don’t control the Republican agenda. You’ve got to be at least a little bit of a tinfoil hat to think that way.Report

4. you seem pretty optimistic about hcr, ed. and i’m just not sure that’s justified. if you’re a republican you really have little reason to pass any version of hcr – blanket opposition is paying large dividends.

   moreover, the last time reform died was almost twenty years ago. and before that also twenty years (and also before that too). if this bill fails, i’m not sure that political system has the right incentives for anyone to try again for a very long time.Report

5. Steven,

   What do envision as a better Republican Party? What should be the Republican agenda?Report

6. I’d prefer state-by-state healthcare reform as well. Most other insurance is chiefly state-regulated. But I know the response here in Florida would be “no, we’re not paying a state income tax so your kids can have insurance when they’re older, we’re on Medicare already,” or I’d propose it myself. Also, the Republicans have a huge majority here. (I should disclose here that I’m a Florida House intern as of last week, and only have health insurance thanks to a state university student mandate+subsidy).

   I don’t like the federalizing impulse any more than anyone else here, but I realize it largely comes from people of minority views wanting to override the local majority.

   As for the Massachusetts race, I really can’t blame anyone for not supporting Coakley – except the Democratic primary voters who nominated her or course.Report

   1. a.) congrats on the internship
      b.) yeah those old people are a pain…
      c.) the problem with that is a local minority wanting to overcome a local majority binds a distinctly not local everybody.Report

      1. a) Thanks. I will probably need to restrain my comments here a bit more, but honestly I should anyway. I also
         c) Yeah, I know that. That’s partly why I don’t like it very much, as I said.Report

7. Mike~
   I would like a Republican party that was actually serious about governing the country. I would like a Republican party that wasn’t led by cynical entertainers. I would like a Republican party that didn’t think the answer to every foreign policy issue was to blow somebody up. I would like a Republican party that would work to a constructive solution to the Medicare funding crisis rather than declaring any Medicare cuts off the table. I would like a Republican party that was actually serious about getting the deficit under control. I would like a Republican party that was serious about reducing the size of government. I would like a Republican party that actually respected the rights of individuals. I could go on, but you get the drift. I’m not going to hold my breath on any of it.Report

8. As for many people who want to reform health care but see huge flaws with the proposed legislation, of course, it’s not like it’s a glaring contradiction to have supported Brown and to have just barely supported the bill. Maybe this offers a chance for a better bill ion some way (I am not optimistic about that, but hey, you never know). I just wondered where the early and strong “X-factor” or “Freak Out,” as various bloggy people have called it, which started last night among Dems ands very nearly derailed the effort earlier today (possibly a bit more momentum gathered as evening fell???) left you regarding reform/support for Brown now that it actually happened.Report

   1. I shouldn’t really call it “proposed legislation” any more, come to think of it. It’s actual legislation now — two bills passed by separate chambers, either one enthusiastically supported by the president, built around the exact same basic structure, with only relatively minor reconcilable details (and one broadly-accepted-as-a-negotiating-chip public insurance option) distinguishing them — that we are now proposing to junk. Whatever else happens, I think we can say that no president will ever get this close to comprehensive health insurance reform again in this country and not get it done. Or not.Report

9. One other thing I guess: I suppose what I was really asking E.D. was whether he would agree with those (including, obviously, Scott Brown and every other Republican in Washington) who say the athe result last night rightly means that the Democrats shouldn’t now go ahead and pass a bill of the scope of the passed legislation, whether a version that reconciled the House and Senate versions, or simply the House passing the Senate’s version. In other words, do you agree that the voters have spoken and that therefore such a bill should not now pass (as in, it would be wrong, not as in it would be unwise from the perspective of a party trying to maintain power)? Or are you now indifferent about that question, or do you think the bills on the table still be reconciled and passed if possible? And if so, do you feel that way less strongly, more strongly, or equally as strongly as you did before the voters of Massachusetts were heard? Just curious.Report

   1. I do realize this is pretty much a moot point at this point. (I think.):

      http://www.nytimes.com/2010/01/21/health/policy/21health.html?hpReport

   2. I’m not sure, Michael. If they can do it without changing it than I think that would be okay. It was legitimately passed and if that’s what they want to go with then that’s what they want to go with. If they want to change it I suppose they should vote on it again. I don’t think the people have spoken definitively one way or another.Report

      1. Very sensible, thanks. Clearly changes would require more votes. Here’s the view of a familiar person around here:

         http://obsidianwings.blogs.com/obsidian_wings/2010/01/pass-it-or-go-home.html

         –“Sarah Palin, sure. She’s scrappy.” Love it.Report

10. Or maybe not:
    http://voices.washingtonpost.com/ezra-klein/2010/01/is_health-care_reform_stabiliz.html

    Not sure at this point. That’s why I’m interested in E.D. view of what should happen now.Report

    1. That was regarding the moot point point, in case it was unclear.Report

11. I second Steve Donegal. Somehow, the Republican Party began to practice everything it opposed in principle. If you are a deficit hawk, I am, based on the last 30 years, how could you vote for a Republican? What happened to realism, the kind advocated by Scowcroft? Why did neocons become ascendent?

    I would also add that I would like someone(s) on the right to take up the issue of health care reform as a real cause. The few Republican proposals for health care reform were minimal in content and some seemed mostly aimed at things like TARP.

    SteveReport

    1. I can answer one of those questions.

       “Why did neocons become ascendent?”

       9/11. A lotta folks lost their shit for a few years.Report

12. Brown is not about Democrats and Republicans as I wrote about on my own blog today. Much more interesting than that.

    Healthcare is not a system that the government can manage with levers of power unless it buys the whole system and puts all the competitors out of business. Like if Google bought, Microsoft, Yahoo, Cisco, Juniper, AT&T, Verizon, T-Mobile, AOL, all the little IS connectors and everybody else and then ran the entire Internet. Let me know how that works without trillions of dollars and steady revenue, taxes, to keep it afloat? Bet you get lots of innovation and new ideas that way too! Ready to sign up?

    Medicare and Social Security will break the Federal budget in a few years. Medical care is stupid expensive in America. Medical costs are breaking small business. Too many people in America have no medical care and that is wrong. And I do not trust, want, believe that Congress and politicians can, should, or even be allowed within 500 miles of trying to run medical care from Washington.

    Congress can level the playing field, like reorg Medicare to a hard assed cost control HMO and let Kaiser run it with PPO doctors only that are employees of the system and are paid by the system only. They can make insurance companies take pre-existing conditions. They can prosecute medical care fraud, re-do malpractice torts, and make insurance companies compete across state lines. Then let the states take over like MA does with votes and debate inside each state.

    But before they do any of that JOBS JOBS JOBS JOBS JOBS. Nobody gets medical care if America is broke and unemployed and we continue to give all our jobs away to China and India and everywhere else.Report

13. There is one thing to record about Scott Brown (not HCR-related). In his victory speech the other night, Senator-elect Brown said that Obama is “giving new rights to terrorists,” and that one reason he was going to Washington because he wants to oppose Obama’s “giving new rights to terrorists.”

    It’s worth not letting that fall by the wayside amid hopes that Mr. Brown represents a new kind of Republican.Report

14. Mr. Kain, I’m sure you’re a nice guy, but when it comes to the Republicans becoming reasonable about anything, especially health care reform, well, you’re delusional.

    I predict the Republicans will not do anything to give the President anything that looks like even the smallest success.

    They’re committed to seeing the administration in ruins, and, if it means trashing the country, well, I think they’re perfectly willing to do that.

    Hell, how did we get here in the first place? Eight years of ruinous policies, and they act as if they had nothing to do with it.

    Matt Yglesias has it exactly right here:

    “The Republican strategy of holding out for total surrender is working just fine. They had an interesting theory that if you refuse to cooperate with efforts to make the country better, things won’t get better and the out-of-power party will benefit. The theory appears to be true.”

    Wake up.Report

15. Here, everyone who thinks the Republicans are going to behave decently needs to read this:

    http://corner.nationalreview.com/post/?q=NzI1Y2RkMWE3ZjE4M2QzMzdjZjgyYTEzNWU2MmZhZGQReport

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