Sound Off



Patrick is a mid-40 year old geek with an undergraduate degree in mathematics and a master's degree in Information Systems. Nothing he says here has anything to do with the official position of his employer or any other institution.

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257 Responses

  1. Avatar Tod Kelly says:

    I’m not sure how you would choose to file me.  I don’t support the PPACA because it fails to accomplish the thing most needed: controlling costs.

    On the other hand, since I don’t think the free market will solve the various issues with health care, my guess is that Koz sees me as a supporter.Report

    • Avatar Patrick Cahalan in reply to Tod Kelly says:

      Since Koz is insisting that “lukewarm support” is equivalent to “full support”, let’s stick with a “Yea” or “Nay” to remove any ambiguity.

      How would you vote?Report

      • Nay.

        There are things about the bill that will plug the dam temporarily, but they push the real problems off to the future – where they will be larger and more difficult to deal with.

        (That being said, this should not be taken to be read as a “There’s nothing wrong with the system!” and so I think Koz would still count me as a supporter.)Report

        • Avatar Stillwater in reply to Tod Kelly says:

          Huh. I read you as a reluctant ‘yea’. Sorry bout that.Report

          • Avatar Tod Kelly in reply to Stillwater says:

            Oh, don’t get me wrong, I believe that health-care reform is necessary, as is government over site or maybe even control.  And I think anything that does not have mandatory coverage will be a waste of time.

            I just think that what we got was a punt to 10 or 15 years down the road.  I think we need to take care of the underlying issues, and we need to do it now.Report

            • Avatar Stillwater in reply to Tod Kelly says:

              Yeah, I hear that. But let’s suppose that the ACA is the best possible bill that could have come out of Congress (rejecting all the Digby/progressive rants about Bully Pulpits and Leadership and the rest of it). If that’s true – and there’s no reason to think it isn’t true –  then addressing the real issues in any more substantive way than the ACA would have been impossible.

              So the issue, for me, goes back to this: is the bill better than the status quo? In my mind, unequivocally, the answer is yes.


        • Avatar Koz in reply to Tod Kelly says:

          I’m really glad you wrote this because we’ve got the chance to clarify a few things.

          At the time that when the dispute was raging, there were really three issues under consideration.

          1. The health policy effects of PPACA.
          2. The political strength and viability of the Demos and the cultural status of the libs.
          3. The sovereignty of the American citizens.

          It’s been pointed out, then and now, that it’s a measure of exactly how bad PPACA was that at that time the policy considerations were secondary for the most part, even in spite of how big and radical PPACA was.

          For the most part, the intent behind the support for PPACA was to protect political viability of the Demos and the cultural status of the libs. For me, it’s all the same. If Lieberman or Baucus or whoever could have killed this vampire at an opportune time, it’s win-win-win all the way around.

          But for you, if you opposed the bill for whatever reason to the extent you were willing to see the Demos take a hard one in the nads, then you’re definitely a nay in my book.Report

          • Avatar Stillwater in reply to Koz says:

            For the most part, the intent behind the support for PPACA was to protect political viability of the Demos and the cultural status of the libs.

            My take on it is different. If you run down support for individual provisions in the bill – guarantee issue, end of rescission, no lifetime caps, extensions of medicaid, etc – you find overwhelming support. And most people conceded that a fair trade for getting those provisions was the insurance mandate, which kept the insurance companies in the loop. What most people objected to was the lack of a public option on the premise that a PO could, over time, develop into a single payer system thereby cutting out private insurance from the equation. (Personally, I think this view suffered from a couple of pretty serious failings, but whevs.)

            So people supported the broad efforts of the ACA, but some very vocal folks criticized it (strenuously!) for failing to include the PO. And that provision – mistaken as it might have been in the short term – was their line in the sand. I don’t think people supported it out of loyalty to liberalism. In fact, just writing that sentence makes me laugh.Report

            • Avatar Koz in reply to Stillwater says:

              “If you run down support for individual provisions in the bill – guarantee issue, end of rescission, no lifetime caps, extensions of medicaid, etc – you find overwhelming support.”

              First of all, this is a highly dubious argument on its merits. More than that, it’s completely irrelevant. Even if it were true, it would be up to the libs and Demos to convince the American people that their plan really does what they want. They tried very hard to do that but miserably failed.Report

              • Avatar Stillwater in reply to Koz says:

                I thought your argument was that liberals supported the ACA out of loyalty. Now you’re saying that liberals <em>don’t </em> support the ACA. Which is it, brother? I can’t argue against moving targets.Report

              • Avatar Koz in reply to Stillwater says:

                It seems reasonably clear to me. The idea is that the liberals deluded themselves into thinking that the opposition of the American people is some irrelevant random datum. The reality is that the libs tried very hard over and over again to get buy-in from the American people on PPACA and couldn’t do it.Report

  2. Avatar Tom Van Dyke says:

    The “…but the Republicans suck worse” thread was the League’s real Rohrschach test.

    As for Obamacare, there are various reasons to oppose it that have nothing to do with its goal, as Tod Kelly shows here, so it’s not entirely probative.Report

    • Avatar Tod Kelly in reply to Tom Van Dyke says:

      “The “…but the Republicans suck worse” thread was the League’s real Rohrschach test.”

      This seems less a League thing that an overall societal thing.  The GOP may be just as good or better than the DNC, but that’s not the way most people see it.Report

    • Avatar Patrick Cahalan in reply to Tom Van Dyke says:

      Tom, I have to say, right now I agree with the “GOP sucks worse than the Dems” meme but for very particular reasons, most of which are constructed, not inherent.

      This isn’t anywhere near to saying that “conservativism sucks worse than liberalism”, because I think both approaches have drawbacks and advantages.  Hell, I’m on record saying Romney probably won’t practically be much worse of a President than Obama, if at all – so if you’re comparing those two cats as representative of their parties, the actual difference between the two is a sliver of daylight.

      Heck, if you believe in gridlock, then having the GOP be in the minority is better than having the Dems be in minority, because when the GOP is in the minority they’re obstructionist.  When the Dems are in minority they’re a nonentity.  For all the damage done to the country during Dubya’s stretch (and I’ll gladly throw down as saying Dubya was a bad President), the Dems have plenty of culpability.  They could have been then as obstructionist as the GOP is now, but they were all afraid they were going to lose their jobs.Report

  3. Avatar Jesse Ewiak says:

    This came up during the time I was posting my message on the other thread so I guess I’ll move it.

    Short Answer : Aye, with reservations.

    Long Answer :

    Speaking specifically about health care since my vote is being assumed, I was in favor of the PPACA, but largely because I understood it was the best thing possible that Ben Nelson (for conservaDem reasons) and Joe Lieberman (for being an asshole reasons) would vote for. I would’ve preferred a public option, but the increase in eligibility for Medicare and the subsidies makes me less pissed off about the individual mandate than other liberals.

    On the ‘majority is against the PPACA’ question, yes, the majority of people ‘disapprove’ of the PPACA or Obama’s health care bill if you ask them. But, if you ask them about the major plans of the health care bill (expansion of Medicaid, rise in max age kids can be on health care plans, no discrimination on preexisting conditions, etc.), you get majority support for everything accept for the individual mandate. I’m sure I can see multiple bills that Koz supports with far less support when you break them down piece by piece. 🙂Report

    • Avatar DensityDuck in reply to Jesse Ewiak says:

      Doesn’t the setup of the poll question imply that “aye with reservations” means “nay”? If you think it should be changed then you obviously don’t “support PPACA as enacted”…Report

      • Avatar Patrick Cahalan in reply to DensityDuck says:

        Not necessarily.

        If you don’t like it, but you think it was the best you were going to get and you’re willing to vote for it on that basis, you cast the die and vote yes.

        If you don’t like it, and you think you could have gotten better, you cast the die and vote “no”.

        If we don’t have an up-or-down vote, everybody will provide answers so complex that you’d be able to suss out whatever sort of “support” or “lack thereof” you want, really.Report

      • Avatar Jesse Ewiak in reply to DensityDuck says:

        As I said in another part of the thread, I would have zero problems voting for the PPACA. Zero.

        But, the next day, I’d be filing an amendment to various parts of the bill. Because, I think the PPACA is better than the status quo, it’s not my preferred outcome. But, it’s closer to my preferred outcome than the status quo.

        If politicians only voted for things they fully supported with no reservations, the Federal Register would be about three sentences.Report

  4. Avatar E.D. Kain says:

    I support Obamacare because I view it as a first step. Its flaws are manifold. Its shortcomings are obvious and disappointing. But with time it will probably make our healthcare system look and function a lot more like Germany’s or Switzerland’s and these are also probably the only models we ever had any hope of emulating to begin with. So I see this as a small step in the right direction.

    That Koz should think the majority of people here support it is what truly baffles me.Report

  5. Avatar Ryan Bonneville says:

    I guess I also get filed under “yea”, although it has little enough to do with genuine support. I think anything short of single payer is a massive injustice and mostly an idiotic way to run a health care system in a country where we aren’t going to just let people die for no good reason. I don’t think Mandate, Regulate, and Subsidize is a sustainable long-term model for the same reason cited by Tod Kelly – it won’t control costs.

    Notably, of course, I disagree with Mr. Kelly on the question of whether that’s the thing “most needed”. The fact that my primary goal for health care reform is providing coverage for everyone probably goes a long way toward explaining the difference between my hesitant yes and his qualified no.Report

    • Avatar Stillwater in reply to Ryan Bonneville says:

      Good points. I actually skipped over the most important features of the bill from a health-care delivery pov: that it extended medicaid to millions of uninsured poor and elderly, and mandates guarantee issue/end of rescission/not lifetime caps/etc for insured. So, I definitely disagree with Tod that provider costs are the biggest issue in all this. But after that, what Tod said above.Report

  6. I don’t like it because I don’t think it has been effective in curing the probems it was supposed to AND actually harms the things that were working (FSAs being the biggest impact to me).Report

  7. Avatar Jaybird says:

    Nay. And the fact that Koz thought that I was is flabbergasting to me.Report

  8. Avatar greginak says:

    My answer is similar to Jesse’s. I support it although there a bunch of things i think could be better and i would have preferred a public option. Given it was the only actual option presented it is clearly the best of the one choice we had. No i am not considering the bills put forward with no support as actual option. As a demonstration of how the US makes public policy it was clear indicator the US is mega forked and we deserve it. Most of the debate on health care was more appropriately called the Sophistry Olympics.Report

  9. Avatar DarrenG says:

    I’m with Jesse and Erik and am a “yea, with reservations.”

    In an ideal world I’d prefer something more like the Dutch or Japanese system, but I see the PPACA as a large step forward from the prior status quo.Report

  10. Avatar Stillwater says:

    I’m with Tod above: on balance I think it’s a move in the right direction. Personally, I’d’ve liked to see a PO or at least a medicare buy-in, but the ‘subsidy’ to the insurance companies isn’t a deal breaker for me. And I agree with Tod that the biggest problem we face is constraining health-care costs, which the ACA does a poor job of, tho I think it does achieve some of this (reducing the insurance loophole for employers, providing indirect incentives for insurance companies to constrain provider costs). And I strenuously(!) agree with Tod that market based solutions would be unlikely (highly unlikely) to achieve the intended goal. Furthermore, I don’t see any reason to favor market based solutions for this type of service in any event.

    So yes, I’m in favor but came to support it only reluctantly (only after several months of my criticisms getting shredded by smart people who knew more about it than I did).Report

  11. Avatar wardsmith says:

    Everything wrong with the bill is summed up here. 2500+ pages and “lawmakers” had no idea what was inside it? IIRC student loans were somehow considered part of healthcare? This bill had nothing whatsoever to do with actual health care and everything to do with ham handed “patricians” deciding what is best for us, because our pretty little heads are obviously too small to figger it out for ourselves.

    All the other arguments that are going to show up here, like “if only we could have had single payer, but those evil Republicans wouldn’t let us!” are utter bullshit. Not ONE Republican voted for the bill, the Democrats had a filibuster proof super-majority, they didn’t give a rat’s ass what the Republicans thought, but were (rightly as it turns out) worried about what the public might think if they saw the guts of what they were attempting.

    The Medicare Part D BS that the Republicans pushed through under /their/ super-majority was almost as bad, but at least they had the decency to allow debate and discussion. The high-handedness of the Democrats on this bill was their undoing.Report

    • Avatar Kimmi in reply to wardsmith says:

      Student loans needed fixing. So too did Nelson.

      Do you have something in principle against the Coburn Omnibus?Report

    • Avatar Jesse Ewiak in reply to wardsmith says:

      1. Yes, a bill to restructure large parts of a sector of the economy can’t be done in three pages. Sorry. Life is complicated.

      2. Effeciency! Why take two bills that can be done in one bill, especially when both of those things are supported by everybody voting for the bill? That’s one of the few good things about the Senate – you can put anything in a bill and it’s all germane.

      3. Um, most of the liberals I know rightly blame conservaDems and Lieberman for torpedoing the public option. We all know the GOP didn’t kill the public option. OK, maybe Olympia Snowe did a little bit.

      4. Can we stop this, ‘there was no debate’ BS. There was literally months of debate. Hundreds of Republican amendments made it into the bill. A whole summer was spent with Max Baucus and Senate Republican’s playing grabass. In a Congress run by Speaker Schilling and Majority Leader Ewiak, I guess much less consideration would’ve been taken. 🙂Report

      • Avatar North in reply to Jesse Ewiak says:

        Seriously, half the left wings irritation with Obama stems from just how much crotch kicking he stood and took from the GOP during his first year in office.Report

      • Avatar wardsmith in reply to Jesse Ewiak says:

        1) Impacting 1/6th of the economy during an economic downturn – not a bright idea. Throwing everything /and/ the kitchen sink into a single bill – recipe for disaster and fraud and pork. Sorry, you lose

        2) Hogwash

        3) That’s not the narrative – look around beyond your narrow corner of the net

        4) No debate here. A little bitter lesson for you and Obama – you still don’t get it.

        I don’t even have to be partisan about this. Obama blew it pure and simple. Pelosi and Reid blew it. Given the same hand I suspect even Schilling and Ewiak could have played these cards better – but your partisanship might be your own undoing also, you might have blown it even worse, if such a thing is possible.Report

        • Avatar Kimmi in reply to wardsmith says:

          So you think we ought to spend Three or Four weeks of government time arguing over everything that Coburn has a hold on?Report

        • Avatar DarrenG in reply to wardsmith says:

          Yes, after 15 months of bad faith negotiations and obstructionism, they finally wised up and cut the GOP out of the final conference process once the bill was done, for exactly the reason stated in the article:

          “GOP leaders have vowed to try and block a final bill from reaching Obama’s desk. “This fight isn’t over. My colleagues and I will work to stop this bill from becoming law,” Sen. Mitch McConnell, R-Ky., the Republican leader, said shortly before the Senate cleared its version of the bill last month.”

          That doesn’t somehow make the year-long debate and negotiation process that happened prior disappear, though.Report

        • Avatar Jesse Ewiak in reply to wardsmith says:

          1) Um, I disagree. The greatest progressive bills in history were passed in an economic downturn. Sorry, try again.

          2) It’s the truth. You may not like it, but bring it up with the Senate. It’s been done with literally dozens of bills, if not hundreds in the history of the Senate. By both parties and both ideological persuasions.

          3) I travel all over the ‘Net. I read DailyKos, I read Balloon Juice, I read here, I read the Corner over on NRO. 95% of articles by liberals about the public option blame Lieberman and Nelson. Some may blame Obama for not drawing a line in the sand, but even that has become a small minority opinion as people have learned more. So, I know the narrative pretty damn well.

          4) Yes, after months of playing footsie with the GOP, Obama and the Democrats finally decided to pass the damn thing. They held the majority in the Senate, the majority in the House, and any Congress at any other time could’ve done the same thing. There’s no requirement for reconciliation. If you can pass the same exact bill in both houses, good for you.Report

          • Avatar wardsmith in reply to Jesse Ewiak says:

            1) Your and my definition of “greatest” surely differs. I am in line with what you mean by “progressive”, ie liberal. We could have a discussion elsewhere about what a screwup FDR made of the economy during the (his fault) extended depression.

            2) It’s been done before isn’t an argument. If you LIKE porkbarrel politics why not just come out and say so, instead of hiding behind precedent.

            3) Your PR machine has done a good job then? Glad we got that straightened out.

            4) The Baucus committee made up of 3 Dem’s and 3 Rep’s did not constitute an open debate, especially considering they were negotiating behind closed doors.BTW the real reason elements of the bill didn’t make it was the raucous town hall meetings.

            5) Just because a bill /can/ pass, does that mean it /should/ pass? We have a representative democracy here, what happens when the representatives REFUSE to represent their constituents? Hopefully they get voted the hell out of office. Oh wait, that happened, thanks to the Tea Party. No wonder the “smarter than thou” Progressives are furious with them. Can’t very well take over a country (against its will) when it stands up to you. Not to worry, there’s always the courts. Of course that knife cuts both ways.Report

            • Avatar Kimmi in reply to wardsmith says:

              You sure you’re not from Oz? (like ron paul?)Report

            • Avatar Jesse Ewiak in reply to wardsmith says:

              1) So you’ll be sending your SS checks back to the  government uncashed then?

              2) I have zero problem with pork barrel politics. If I can get somebody to vote for something great by building a bridge, cool. I’m not an idealist. My political hero domestically is LBJ.

              3) Um, sure.

              4) Again, we had literally hours of open debates in town halls, on television, on the radio, in schoolhouses, at bars, and all over. Literally, if you ask the normal person on the street if we didn’t have enough debate on the health care bill, they might hit you in the face.

              And Baucus’ bill didn’t pass because it was never supposed to pass. It was a marker to negotiate within the Democratic caucus.

              5) Sure. If the GOP can get 218 votes in the House, 51 Senate votes (because I assume they’ll kill the filibuster in 12.6 seconds if needed), and a Republican President, they can repeal. Then, in 2016, we’ll pass a better version of the PPACA you’ll hate even more.Report

              • Avatar wardsmith in reply to Jesse Ewiak says:

                Enough on the “debate” Jesse. Two years after it began you don’t even KNOW what is contained in those 2500 pages. How much have you read personally and how much is “pre digested” for you on your favorite blogs by your favorite writers? That’s even before nameless gnome bureaucrats in the gov’t start codifying what is in the 2500 pages of the bill into millions of pages of regulations. How well do you imagine John Q. Public is informed on this debate? Isn’t an uninformed electorate part of the progressive’s strategy? This is all right out of Alinsky’s playbook.Report

              • Avatar Jesse Ewiak in reply to wardsmith says:

                I haven’t read ever rule OSHA has, but I’m pretty sure most of them are necessary. Same thing with the PPACA.

                And I go back to you. How informed is the American public on what we spend money on? How informed are they on how much a $x dollar cut to thing y would effect them? By that measure, we shouldn’t cut any spending either. We’re not a direct democracy. We’re a representative republic.

                But, by bringing out Alinsky as a defense, I see you’re nothing but doing a nice impression of a right-wing troll, so yeah, this debate is done. When not even the normal conservatives on this site are defending you, things aren’t that great for you.Report

              • Avatar wardsmith in reply to Jesse Ewiak says:

                Why would I need anyone to “defend” me against lil ole you? TVD made essentially identical points downthread, I don’t see you bringing up the same claptrap there. I brought up the representative democracy point first, upthread, when you decided to disagree with me on every point you could. YOUR side is losing its ass because your side blew it, representative democracy is working.Unfortunately for your argument, your own politicians redefine idiocy in speeches.Conyers said. “What good is reading the bill if it’s a thousand pages and you don’t have two days and two lawyers to find out what it means after you read the bill?” This entire OP is evidence of that, you’re just crying sour grapes over middling issues and ignoring the midden that is your side’s bill. Grow a pair and take some ownership.

                Don’t whine to me about Alinsky, everyone knows it is page one of the liberal/progressive playbook, hell it IS the playbook! The bad news for your side is conservative playmakers have read the same book and worked out countermeasures, ones your side can’t figure out how to overcome with the old same techniques.

                As for trolling, I engage in topical discussion and I, unlike you and Kimmi, use evidence and links to back up my points. You on the other hand just bloviate. Who’s the troll in that scenario?Report

      • Avatar Koz in reply to Jesse Ewiak says:

        “Can we stop this, ‘there was no debate’ BS. There was literally months of debate.”

        Yes, a debate that the libs lost as completely, definitively and conclusively as any policy debate in the public square has ever been, and then they went and did it anyway.Report

        • Avatar North in reply to Koz says:

          Well so long as you agree there was a debate at least the “The legislation was rammed through without any debate” canard can be put to bed and we can focus on the issues of PPACA itself rather than the process.Report

          • Avatar Koz in reply to North says:

            No, it means that instead of “the Demos rammed it through with no debate”, we have “the Demos rammed it through against the determined opposition of the American people.” It’s the same diff really.Report

        • Avatar Jesse Ewiak in reply to Koz says:

          Great. And they paid a price for it. Now, convince 218 House Republican’s, 51 Republican Senator’s, and a Republican White House to sign a bill that will throw twenty-five year olds off their parent’s insurance, allow insurance companies to deny people because of preexisting conditions, and eliminate subsidies to help people buy health insurance, and see how well you guys do in the midterms. 🙂Report

    • Avatar DarrenG in reply to wardsmith says:

      Student loans were part of it because eliminating that particular bit of egregious corporate welfare was part of the funding mechanism.

      the Democrats had a filibuster proof super-majority

      Not true, at least by the time it came up for a vote. Remember that whole Scott Brown thing?

      The Medicare Part D BS that the Republicans pushed through under /their/ super-majority was almost as bad, but at least they had the decency to allow debate and discussion.

      The Republicans had only 51 Senators when Part D passed, and only 42 voted in favor of it.

      And yes, what Jesse said on the “no discussion or debate” canard.Report

      • Avatar DensityDuck in reply to DarrenG says:

        “Student loans were part of it because eliminating that particular bit of egregious corporate welfare was part of the funding mechanism.”

        Just like the 1099 Rule and banning ad hoc utilization of HSA’s, right?

        Gotta find those pennies somewhere.Report

    • Avatar North in reply to wardsmith says:


      Not to quibble too much Ward but if the GOP had offered something (anything) Obama and the centrist dems would have trampled the leftist dems flat in their stampede to endorse and enact it. Heck, half the reason PPACA looks the way it did was because Obama attempted to compromise out the gate by starting with the GOP’s 1994 health care proposal.

      Now the GOP tried (and almost succeeded) in getting their preferred choice; no change at all. At which point the Dems most assuredly did go high handed and enacted PPACA with only their own votes. But to claim that the GOP was locked out from the get go strikes me as disingenuous.Report

      • Avatar Robert Cheeks in reply to North says:

        Dear North, the point is ‘the people’ don’t want ANY fishing commie-care..none, zero, nada!Report

      • Avatar wardsmith in reply to North says:

        North the bill they started from was the 1994 Republican one. Their problem was they didn’t acknowledge the tort reform provisions whatsoever (because the Dems are owned, lock stock and barrel by the trial lawyers), the HSA provisions and the crossing state lines provisions from the original bill. There were other intelligent and cost-saving ideas that didn’t make it either. Also the times change and the bill didn’t change enough. Obama was more concerned with history making than good policy making. He also did not lead the process at all. And when the Reps complained about being shut out did he not famously say, “Elections have consequences”, while essentially telling the Republicans to shove it? To quote his “spiritual adviser” those “chickens have come home to roost”.Report

        • Avatar Patrick Cahalan in reply to wardsmith says:

          Ward, some direct cross-x

          “they didn’t acknowledge the tort reform provisions whatsoever (because the Dems are owned, lock stock and barrel by the trial lawyers)”

          The amount of waste in the medical system due to tort reform is up for debate.  Both political parties get a substantial portion of their donations from the legal profession (the Democrats do skew higher), however the GOP gets a higher percentage of their donations from the Health industry, and more from the Insurance industry (see

          “the HSA provisions”

          Not sure which ones you’re talking about.

          “and the crossing state lines provisions”

          This is a rather odd objection for someone who doesn’t like big government in general.  Crossing state lines clearly usurps the existing state insurance commissioner framework.  I would think you would be against this.

          “There were other intelligent and cost-saving ideas that didn’t make it either.”

          Granted.  This is (in my opinion) completely due to the GOP failing to offer legitimate bargaining concessions.  If the GOP proposes these and nobody on the GOP is willing to cross lines to cast a “yea”, that’s hardly a great reason for anyone to listen.  Even if they *are* good ideas.

          Also the times change and the bill didn’t change enough.

          Without knowing what the alternative is, I can neither agree or disagree.

          Obama was more concerned with history making than good policy making.

          I think this is hugely uncharitable, but probably accurate to a small degree.  I would rephrase to say I think Obama was more concerned with getting something passed that could be fixed than getting it right in the first place, something more or less echoed by the supporters of the bill on this thread.

          He also did not lead the process at all.

          Agreed.  I think this was a huge mistake.

          And when the Reps complained about being shut out did he not famously say, “Elections have consequences”, while essentially telling the Republicans to shove it?

          Well, to be fair, if I’m trying to negotiate with someone on their base proposal over the course of several months and nobody will do so in good faith, I’m going to be inclined to tell them to go stuff themselves, too.  Bad political move, though.Report

          • Avatar wardsmith in reply to Patrick Cahalan says:

            Tort: asked and answered elsewhere, but I recommend you read this. It even includes a graph showing contributions and calls out notable trail lawyer Democrats. This is a non trivial concern to actual Physicians. Virtually every neighbor in my HOA is a doctor plus a trial lawyer that they all hate. I tried to be friends with him for years until I came to the realization that he really was just an asshole.

            HSA was hated by the Dems when originally passed and they’ve been gutting it ever since.

            There’s no intelligent reason I shouldn’t be able to buy insurance that is 30% cheaper from the state that is 15 miles away. Making states little monopolies flies more in the face of my libertarian ideals than relinquishing that monopoly.

            No time for the rest of your points. Bottom line, the bill sucked, the majority of honest posters here agree with that ergo it should not have passed. QED.Report

            • Avatar Jesse Ewiak in reply to wardsmith says:

              Not going over the other stuff, but I ask you, if insurance companies were allowed to sell across state lines, why wouldn’t insurance companies do as credit card companies did and go buy a state legislature and move all their operations there? Less regulations and more profits. Win-win for the insurance companies.


              • Avatar Jaybird in reply to Jesse Ewiak says:

                There’d be no illusions about whether they were engaging in “Interstate Commerce”, though. “Fewer regulations” would risk becoming “WHA-BAM!” every new Congressional session.Report

              • Avatar Jesse Ewiak in reply to Jaybird says:

                Yes, as we’ve seen with the tough regulation of credit card companies since they did the same thing. 🙂

                Sorry, I don’t buy it. The only way to allow cross-state insurance purchasing is if the insurance company has to comply with the regulations of the state they’re selling in, not the one they’re headquartered in.Report

              • Avatar Jaybird in reply to Jesse Ewiak says:

                Biden’s gone now. We’ve seen a lot more interesting Credit Card legislation since he left the Senate, no?

                Just a coinkydink?Report

              • Avatar Jesse Ewiak in reply to Jaybird says:

                Yes, it’s interesting, but doesn’t actually limit the powers of the CC companies that much. Now, they CC have to tell you’re they’re going to bend you over before they do it.

                Eh, Delaware still has two Senators. The problem was that Biden’s replacement didn’t care about reelection since he was just a seatwarmer. So, an influence? Probably. The reason it passed? Not really.Report

              • Avatar wardsmith in reply to Jaybird says:

                My last post – gotta get back to work, but interestingly JB, you’ve hit a nail squarely on the head. Since insurance is NOT available across state lines (each state having its own version even if the company is nationwide) Burt is wrong that it will fit under the “Interstate Commerce” clause in SCOTUS. Whether the attorneys arguing this do a competent job remains to be seen however.Report

            • Avatar Patrick Cahalan in reply to wardsmith says:

              If tort reform is such the major driver, that seems like you can bolt it onto PPACA pretty easily, Ward.Report

              • Avatar wardsmith in reply to Patrick Cahalan says:

                To fix PPACA requires starting over. You write code don’t you? Would you try to “bolt on” a new module to pseudo-repair a stinking pile of excrement that everyone hates?

                Contrary to Jesse’s imagineering, the era of one massive bill to solve all the world’s problems in one fell swoop is long over. Especially for something as complex and interrelated as this, the optimum approach is piecemeal solving individual problems at a time. Your cascade software development approach if you will. Introduce modules at a time, see how they fly (or not) and revise or introduce the next one. This /might/ have worked on a state by state basis, but the market power in the smaller states just isn’t large enough and as Mark shows downthread, there are fundamental issues tied into IRS regulations that have caused this mess over the past 40 years. I agree with Thompson, the systemic issue of divorcing the /true/ consumer from the producer has established the market distortions (along with the mess Medicare made) we face now.Report

              • Avatar Koz in reply to wardsmith says:

                This ties in pretty well with what I’ve been talking about with Aaron. Universal coverage is the killer. We can’t cascade development model from where we are to some other health care system with universal coverage in any kind of plausible time frame.Report

        • Avatar North in reply to wardsmith says:


          Ward, much of what you say has salience to it but you are leaving out the most vital point which Patrick noted below: The GOP never offered any votes!

          There was no point where they said “include policies X, Y and Z and we’ll deliver this many GOP votes”. Never. In fact they enforced astonishing discipline on even their most moderate Senators to prevent any chance of cooperation (I still would LOVE to know exactly what horse heads they deposited on Snow’s doorstep). Perhaps you recall their declaration of Waterloo early on?

          If you aren’t offering votes then you aren’t trying to legislate; you’re just playing politics. That’s well and good. Obama failed to lead, the GOP say a chance to kill the whole thing and they went for it. Power to them, good opposition and all that rot; but their gambit failed. They don’t get to pretend they were locked out from the get go. We both know they weren’t. They never tried to get in; they were too busy trying to kill the whole thing.

          They reaped ample rewards from their intransigence. If they’d have succeeded in pulling off the kill then Obama would be in a primary fight for his life right now and the GOP would probably have gotten even bigger majorities in congress and the Senate in 2010. Even without killing HCR they GOP got some nice consolation prizes. But they simply don’t get to try and pretend like they were locked out in informed company. They can spin that to the low info voters (and they will) but no one who paid attention to the process is going to honestly believe it.Report

    • Avatar ThatPirateGuy in reply to wardsmith says:


      What the hell are you talking about no debate. That is a huge fishing lie. We debated for months.

      In the end the country got a bill that made it better. We could have had a better bill but the senate sucks. If the republicans hadn’t filibustered we wouldn’t have has to cater to the dumbest and most conservative dems.

      Once we get the tea party poison out of our system we’ll come back for another try and improve the situation more.

      Heritage can go out back and fish themselves.Report

  12. Avatar Kimmi says:

    I… may be one of the stronger voices in favor, if only because I see many long-term cost-reductions that I think Tod is either discounting or unaware of (not slamming Tod, this may well be a legitimate area of disagreement).

    That said, my “ideal” solution is to go back to circa 1990’s health care, minus a few of the more evil catastrophic plans. That solution was working, dammit!Report

    • Avatar DensityDuck in reply to Chris says:

      Agree. America already has a universal healthcare system. It’s called Medicare. For some reason we don’t want to just let people buy into it. (Christ, letting healthy twenty-year-olds start paying directly into Medicare would be the best thing that system could hope for!)Report

  13. Avatar Koz says:

    Nope, obviously.

    The bigger point is that Jesse’s rationalizations are irrelevant. I would rather the bill had a public option or single payer. The American people really support this part or that part. None of it makes any difference. The fact that there was so much sturm und drang to get as far as they did gives us a very strong presumption that nothing else was going to come into consideration.

    If at sometime around this thread, we as commenters, putting ourselves in place of the Congressmen and Senators who actually voted, would vote no, dealing with the political and policy consequences, then we’re a no. That might apply to Tod, I’m not completely sure.Report

  14. Avatar E.C. Gach says:

    I’m against it because it’s inadaquate, I’m for it because it moved in the right direction, and in a selfish way, because it allowed me to stay on my parents plan till I’m 26.  I have a full-time job but I’m considered a “temp” so I’m not bought into the company benefits fold.


    • Avatar Kimmi in reply to E.C. Gach says:

      I think it moved in the wrong direction. But I’m for it, because the situation is dire, and I don’t see any way to move in the right direction. So, move Goddammit, and hope we get someplace better!Report

  15. Avatar Mad Rocket Scientist says:

    Nay.  Lots of good things in there, but extremely poor mechanisms for execution.Report

  16. Avatar Roger says:

    Nay. For the same reasons you cite in your final paragraph. I used to design insurance products for a living (not in health care). PPACA is what I would have designed if I was intent on destroying the market.

    That said, US health care/insurance is FUBAR and needs major changes.Report

  17. Avatar North says:

    Unhappy support. I don’t like it but it’s better than nothing and puts Dems in a better position to try and tinker with it and fix it over time.Report

    • Avatar North in reply to North says:

      Or the GOP to fix it for that matter. But to abolish it entirely they’ll need to get themselves the same sort of majority as the Congress, Senate and Presidency that enacted it.Report

  18. Avatar JG New says:

    I hold my nose and vote “Yea.”  Yes, it could be better, ideally a single payer.  But does it represent an improvement over the pre-ACA status quo?  I believe it does, and will take even an incremental improvement as a positive step forwardReport

  19. Avatar Renee says:

    Against. Ashby’s law of requisite variety requires a control system to have equivalent variety to the system it controls. In this context, I believe it means dramatically simplifying the system so it can be centrally controlled (national healthcare) or don’t ‘control’ it centrally at all (truly free market) and enact a safety net for care (not insurance). I think the latter is preferable, but the former beats PPACA. PPACA, I think, is the worst of all worlds. Bad incentives, unaccountable bureaucracy, cronyism between pharma, AMA, gov, etc.Report

    • Avatar Stillwater in reply to Renee says:

      But is the PPACA better or worse than the status quo rather than one of our preferred ideals?Report

      • Avatar Renee in reply to Stillwater says:

        Sorry – got carried away. Still a nay. I agree with Mark below that PPACA just amplifies the cost-problems of the previous status quo.Report

        • Avatar Stillwater in reply to Renee says:

          Short term? Long term? Leaving aside the other provisions in the bill that I think justify it’s passage (extensions of insurance to the poor, guarantee issue,. etc) I see the ACA as increasing the skin in the game for a whole slew of participants in the insurance/care provision system. It puts people in the cost-constraint loop who otherwise aren’t. So employers have incentive to keep insurance related costs below a stipulated threshhold; insurers have incentive to keep provider costs as low as possible, and government has an incentive to keep per person cost to a minumum. In the old system, no one had any skin in the game other than employees who were quite willing to go with cadillac plans in exchange for lower salaries/wage rates.

          Why aren’t those features of the ACA sufficient (even if imperfect) to drive down overall costs?Report

          • Avatar Kimmi in reply to Stillwater says:

            not to mention e-records, which are a short term job producer and a long term job reducer.Report

            • Avatar Patrick Cahalan in reply to Kimmi says:

              E-records are an unqualified nightmare.

              Yes, it will be great to have them.  As an IS problem, it is nearly intractable with the conditions that are currently on the ground.  Nothing in PPACA is going to help this, though.Report

              • Avatar Kimmi in reply to Patrick Cahalan says:

                *snort* We’ve had some version of an “e-record” here for the past 15 years (in searchable custom databases, no less). Inpatient, outpatient, nursing home. They’re fantastic research tools, and they do save lives.

                The move is to bridge the gap between “we do it Here” to “we do it here, and we’ll play nice with the health care person down the street”Report

              • Avatar Patrick Cahalan in reply to Kimmi says:

                The move is to bridge the gap between “we do it Here” to “we do it here, and we’ll play nice with the health care person down the street”

                Yes, that’s bridging the gap all right.

                This is not much of a technology problem, and everything about a work process problem.  Thus, getting everybody to agree on a non-stupid framework is a gargantuan information problem.Report

              • Avatar Renee in reply to Kimmi says:

                In the world of technological standards, have we had more success with government mandates or not?  I would hazard a guess that the financial incentives aren’t there to develop a workable standard.  Why, because the systems incentives are all messed up.Report

              • Avatar James Hanley in reply to Renee says:

                In the world of technological standards, have we had more success with government mandates or not?  

                We’ve had great success with ISO, ANSI, Snell, Green Seal, Consumer Reports…all non-government mandated standards.Report

              • Avatar Patrick Cahalan in reply to James Hanley says:

                We’ve also had problems with TCP/IP, SNMP, HTTP, SMTP… all non-government mandated standards.

                While LEED (non-government) has seen great voluntary adoption, SOX (government) has been a nighmare, PCISS (industry) is a mess…

                There ain’t no general rule, in this space.Report

              • Avatar Patrick Cahalan in reply to Renee says:

                It depends on how you define “success”.

                If you mean, “adoption”, then yes.

                If you mean, “adoption, and it was worth it”… that’s a mixed bag.Report

              • Avatar Renee in reply to Patrick Cahalan says:

                Beta-Max!  Beta-Max!

                Seriously though – the advantage non-gov standards have is adaptability.  I’m not techie enough to know the problems with TCP/IP, etc, but I know that it is easy to transfer files and get on the internet.  Why? Because it is profitable for people to make it so.

                If I had a secure way to carry my medical records on my iphone and it was cheap and easy for me to see doctors (oops, sorry PPACA) then the technology would happen nearly instantaneously.Report

              • Avatar Patrick Cahalan in reply to Patrick Cahalan says:

                “If I had a secure way to carry my medical records on my iphone…”

                This is the golden bullet.  It’s not even silver.  It’s golden.  And shiny.

                It’s also pretty hard.Report

              • Avatar Renee in reply to Patrick Cahalan says:

                ‘Hard’ referring to the bullet analogy?  So hard it can get through PPACA’s armor?  (probably not)

                So hard technologically . . . I am certain that if I was paying for health care (directly or via insurance) and doctors were competing directly for my business . . .  there would be an app for that.Report

              • Avatar Patrick Cahalan in reply to Patrick Cahalan says:

                No, hard as in “secure way” is a difficult issue.

                Typically,  security engineering in technology (or anywhere else, for that matter) is already a difficult problem domain.  It’s made even more difficult by the fact that security is very often dealing with huge externalities that don’t respond well to normal incentive structures.

                “there would be an app for that.”

                Oh, there are apps for that, right now.  They are insecure; to be most accurate, they are unreasonably insecure given the data they contain.  Part of this is that the underlying system isn’t sufficiently secure.

                I could write a whole post about *that*, too…Report

              • Avatar Renee in reply to Patrick Cahalan says:

                Naturally, I get into this with the IT phd seeking commenter!  And I would enjoy reading you thoughts on security.  What I’m driving at is that if the incentives are there, we would get to a security position that is good enough.  I use my credit card on the web.  Is that safe.  Not really.  But it is good enough.  Right?  (No really, am I right???)Report

              • Avatar Patrick Cahalan in reply to Patrick Cahalan says:

                “What I’m driving at is that if the incentives are there, we would get to a security position that is good enough.”

                Signs point to “no”.

                “I use my credit card on the web.  Is that safe.  Not really.  But it is good enough.  Right?  (No really, am I right???)”

                You have a lot of protection from credit card fraud due to a law that was passed back in the 70s.  In the US, federal law limits the liability of card holders to $50 in the event of theft of the actual credit card, regardless of the amount charged on the card, if reported within 60 days of receiving the statement.

                But no, credit card security is *horrible*.  It’s also one of the major contributing factors to those sky-high interest rates that everyone is charging right now.  So the security is “good enough” if you pay your bill every month, on time, because you don’t eat any of the cost of fraud.

                Merchants and the people who don’t pay their bills who get hit with 22% finance charges are the ones who are footing the bill for the bad security.  Merchants, of course, pass some of that cost on to all of their consumers.

                The bad security of credit cards is something we all pay for; we just generally do it indirectly so we don’t notice.

                Bad security leads to costs. Somebody has to pay for them.Report

              • Avatar DensityDuck in reply to Patrick Cahalan says:

                “E-records are an unqualified nightmare.”

                I know how cliche this sounds, but: So was landing men on the Moon.Report

              • Avatar Patrick Cahalan in reply to DensityDuck says:

                Oh, it can be done all right.  I imagine Russell might describe the agony for us, in detail.

                There is not one thing in the world more difficult to do than to get everyone at a single organization to use a complicated bit of information technology in a uniform manner*… except to get everyone at multiple organizations of varying sizes with incomplete business model overlap to use a complicated bit of information technology in a uniform manner.

                * unless you have a CEO who stands up at the company meeting and says, ‘Everyone will now put all of their time in their Exchange calendar or I will fire them immediately, no exceptions”… and then sticks to it.  This is pretty rare.Report

              • Avatar Kimmi in reply to Patrick Cahalan says:


                1000 different pipelines, (at least ten different major systems)… but it all works, here at least.Report

              • Avatar Patrick Cahalan in reply to Kimmi says:

                It’s easy enough to say “it works”.  That doesn’t mean it actually does work (or that the benefit outweighs the cost of the thing).

                There’s a whole group of researchers at CGU who do nothing but health informatics research.  Their work is really interesting, you find out all sorts of (in retrospect) crazily obvious problems with monolithic records-keeping.

                By far, the best idea for maintaining health care records is to give the patient everything.  Health care providers don’t really want to do that, however.Report

          • Avatar Renee in reply to Stillwater says:

            Disclaimer:  I don’t work in healthcare nor have I read a single letter of the bill, so (as I would guess of most folks) these are only my impressions.

            I disagree that no one but employees had skin in the game until ACA.  Isn’t employee provided health care, well, provided by someone?  Doesn’t gov’t have skin in the game through medicare/medicaid?  (I forget the figure but the percentage of govt dollars spent out of total health care spending is not insignificant).

            My point about complexity is that the ACA makes those relationships more entangled/regulated/complicated, not less.  It makes health care decision making less direct.  I think it is going to be a monster of unintended consequences.  We’ve already seen insurance carriers dropping coverage of children altogether so that they don’t have to comply with keeping them until 26.Report

            • Avatar Stillwater in reply to Renee says:

              Renee, thanks for the reply.You wrote

              My point about complexity is that the ACA makes those relationships more entangled/regulated/complicated, not less.  It makes health care decision making less direct.  I think it is going to be a monster of unintended consequences.

              I get that. And on your view it’s a decisive complaint – that it makes things worse rather than better. I don’t see it that way at all, so we fundamentally disagree. So let me say more specifically where Ilm at: in the short term, the bill is very beneficial. In the long term, without a legislated solution to the problem of one form or another, the whole health care mess blows up anyway. So the solution for long term viability of health care as an industry is closed to the types of legislation which have a chance of being enacted. That means Congress. So a fortiori, that means no libertarian ideal, no conservative ideal, no liberal ideal. What we have is a short term fix, with the possibility of piggy-backing into a longer term fix.

              That’s how I see it. In what way do you disagree?


              • Avatar Stillwater in reply to Stillwater says:

                ‘Closed’ should be ‘limited’.Report

              • Avatar Renee in reply to Stillwater says:


                I would like to hear more about why you think it is “very beneficial” in the short term.  I would give it mixed-bag at the very best.  Increased coverage is a moral good that I support, but even short term, I think unintended consequences are going to be huge.  We already see the govt granting waivers left and right; insurance companies modifying their behavior (for worse) – raising rates, dropping child benefits; etc.

                I’m not sure why you insist on dragging me back to the world of political feasibility (sheash!) . . . And I certainly agree that the road we were on was not sustainable.  But I think PPACA misses the break pedal and hits the accelerator.  You will have to be more explicit as to what type of long term solution PPACA might piggy-back us into for me to comment on whether it might be good.  If the hope is to blow the system up quicker so we can get to single-payer . . . well, better than the status quo, not as good as free market.

                To be honest, I am not sure we need a radical libertarian free market anarchocapitalist approach.  I think the employer-insurance link (I agree with Mark here) is the fundamental problem.  Recall that the original reason for giving employers a tax write off for providing health care was so that they could compete for employees because the govt was capping wages.  So the entire system we have inherited is a work around to a govt mandate.  The individual market sucks because so few people are in it.  We can have regulations and safe-guards, but why do we insist on getting our insurance through our employer?  With sufficiently liberal protections, is severing that link really infeasible?Report

      • Avatar Renee in reply to Stillwater says:

        In my above terms, compared to status quo: PPACA increases system complexity and decreases control complexity.Report

        • Avatar Patrick Cahalan in reply to Renee says:

          I agree with this, as well.

          It also nearly completely embeds employer-provided health insurance forever, as Mark points out.  Since I think this is a hugely foolish coupling, it’s at least as big of a problem as these two objections.Report

    • Avatar wardsmith in reply to Renee says:

      Renee, please get “carried away” more often. Great writing, don’t hold back girl! 🙂Report

  20. A slightly qualified no from me.

    I emphatically still believe that it doubles down on the single biggest cause of the cost problem by even further institutionalizing the tie between employment and health insurance.  Rather than changing a gawadawful system, it reinforces it.  This is, however, at least somewhat mitigated by the elements of the Wyden plan that got slipped in towards the end.

    I also largely blame the GOP’s utter unseriousness on the issue for the overall crappiness of the bill.  That unseriousness amounted to a complete denial that any reform was necessary at all (whatever they may have said to the contrary, actions speak louder than words and all that jazz).  That ensured that the bill we got was ultimately, in effect, the Lieberman-Nelson bill as opposed to the Wyden-Bennett bill.

    The liberals in the Dem caucus were ultimately going to be willing to support any bill that significantly seemed to reduce the number of uninsured – and perhaps understandably so.  WIth a moderately liberal President and a Dem majority, that pretty much meant that one way or another some sort of health care reform was going to pass.  The question was whether that would mean liberal compromise with centrists (blech!) or the Coburns and Bennetts of the world.  The GOP base made clear early on that any Republican caught negotiating in good faith with a liberal on HCR would find himself out of a job very quickly.  So the liberals’ choices amounted to: take whatever Lieberman and Nelson would agree to, or let HCR go by the wayside.  That wasn’t really a choice for liberals.

    By contrast, conservatives really did have a choice: allow negotiation and compromise with liberals in order to get HCR that was at least palatable (if not an outright improvement) or put all their eggs in the basket of opposing any kind of reform whatsoever.  They chose the latter.Report

    • Avatar Patrick Cahalan in reply to Mark Thompson says:

      This pretty accurately sums up my feelings on the matter.  I’m more of an unqualified no, but this representation of the process that delivered the bill is one that I pretty much agree with.Report

    • Avatar North in reply to Mark Thompson says:

      Quite so. If nothing else Wyden-Bennett is especially illustrative. Senator Wyden, the Democrat sponsor of that well meaning bill, is in office and doing well. Senator Bennett, the Republican sponsor, was defeated from the right by his own party in primary for daring to cooperate with a Democrat.Report

    • Avatar wardsmith in reply to Mark Thompson says:

      Mark, the conservatives were against it because their provisions were completely gutted out of the gate. How can we have healthcare reform without tort reform? You want to reduce prices, reduce unnecessary “defensive medicine” whose only purpose is to give a defense in future lawsuits. But the Dems couldn’t’ do that, they are OWNED by the trial lawyers. The rest was political theater.Report

      • Avatar North in reply to wardsmith says:

         But that’s patently false Ward. The Dems (Obama especially) were ready to bend over backwards to get GOP buy in. The problem is the GOP never offered support for anything. They never even offered a coherent alternative (hell they still haven’t). Their negotiating amounted to “include this policy in your plan and we’ll still vote against it”.

        In fairness I don’t blame them for this. Obama made them think they could repeat 1994, defeat the Dem plan and then yank their own proposals away like Lucy with a football and thus have nothing happen. They almost pulled it off to. But I do find it mightily rich that having failed in this manuver the right now tries to spin like they were never offered participation at all. Hogwash, they had that option. They bet double or nothing instead and they lost.Report

        • Avatar wardsmith in reply to North says:

          I call your “patently false” and raise you the Obama quote from the link you didn’t click:

          Now, I recognize that it will be hard to make some of these changes if doctors feel like they’re constantly looking over their shoulders for fear of lawsuits. I recognize that. (Applause.) Don’t get too excited yet. Now, I understand some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable. That’s a real issue. (Applause.) Now, just hold on to your horses here, guys. (Laughter.) I want to be honest with you. I’m not advocating caps on malpractice awards — (boos from some in audience) — (laughter) — which I personally believe can be unfair to people who’ve been wrongfully harmed

          In his inimitable two-faced style he acknowledges the problem, then “signals” that he’s not going to do anything about it. In fact, in the bill (which you, Jesse and everyone else has NOT read) doctors are STILL on the hook for malpractice even when they follow the mandated guidelines TO THE LETTER!

          Most of my physician neighbors fully intend to retire when this bill is finally enacted. That’s 5 cardiologists, 3 anesthesiologists, 2 vascular surgeons and an emergency room doctor out of the system. That will be replicated across the country, and there are already physician shortages. Don’t mind the 40 million NEW patients jumping into the waiting rooms.

          Healthcare will degrade without a doubt, but it is good time to buy funeral home stocks.Report

          • Avatar North in reply to wardsmith says:

            I glanced over it Ward but setting aside whether tort alone is responsible for a significant portion healthcare cost increases (doubtful in my eyes but that’s debated a lot) this isn’t germaine to the question of the politics which you’re eluding. The GOP didn’t try and get tort reform included and offer concessions of their own. They simply demanded it and indicated that they fully intended to vote against HCR regardless. What a surprise the Dems didn’t include it. Now that’s all well and good, politics is give and take, but they (and you) can’t pretend like they were locked out from the get go. Obama squandered his most valuable year trying to court the GOP and passed the bill with only Democratic votes only once his only alternative was full on failure and political suicide.  A lot of his subsequent problems (especially budgetary ones) stemmed directly from his allowing them to play him for a fool for so long.Report

          • Avatar Stillwater in reply to wardsmith says:

            In his inimitable two-faced style he acknowledges the problem, then “signals” that he’s not going to do anything about it.

            Or, alternatively, he actually <i>concedes </i>that there is a problem but <i>disagrees </i>with the proposed solution. Why think this is two faced? I concede to people all the time that they’re correct in thinking some situation is ‘a problem’, yet I often disagree with them about the proposed solution. Isn’t conceding the opposing sides basic motivation for action X intellectually honest?Report

          • Avatar greginak in reply to wardsmith says:

            Tort reform has already been enacted and in place in many states. Here is a link to a discussion about how tort reform didn’t reduce costs in Texas. You can want tort reform but it hasn’t done much of anything to reduce costs where it has been put in place. The evidence doesn’t support your assertion.



            • Avatar Stillwater in reply to greginak says:

              The most recent numbers I remember hearing about ‘tort reform’ is that it would reduce health care costs by .5%. (Uncited!)Report

            • Avatar wardsmith in reply to greginak says:

              Plenty of folks disagree with that report Greg. Furthermore 54% of money that /should/ go to patients hurt by malpractice goes to lawyers. You should give an honest read to the link I posted above or just read this. If you can’t handle /his/ arguments then you’re just dodging the issue and looking to nibble around the edges.

              Stillwater ignores the rest of my quote, choosing only to defend Obama and ignoring how Obama’s Democrats kow-tow’d to the trial lawyers lobby that owns them. Uncited sources? PuleezeReport

              • Avatar greginak in reply to wardsmith says:

                “First of all, we never promised the tort reform bill would lower the cost of medical care. We said it would increase access to medical care,” said TMA President C. Bruce Malone, MD.”

                So much for tort reform lowering costs. Texas has one of worst rates of uninsured people in the country. Even if the criticisms are true nothing in it rebuts the point that tort reform is already present in some places and has not solved the problems we face. At the absolute most it has caused a slight improvement in patient access. That is assuming your report is correct, there are all sorts of other factors that could have led to results they tout which they don’t discuss.Report

              • Avatar wardsmith in reply to greginak says:

                One thing at a time Greg. Texas was a whopping mess, with trial lawyers shopping venues for friendly judges and crazy jurors. That changed, it was bad and it had to go away. From the article you wouldn’t click on above: Unreliable justice is like pouring acid over the culture of health care. One in 10 obstetricians have stopped delivering babies, unable to pay malpractice premiums on the order of $1,000 per baby, according to the American College of Obstetricians and Gynecologists (ACOG). Some hospitals, including Methodist Hospital and Chestnut Hill Hospital in Philadelphia, have stopped delivering babies altogether; and the number of unnecessary caesarian sections have increased to the detriment of the health of mothers, according to the ACOG.

                So the first problem DUE TO FISHING TRIAL LAWYERS!!! was that obgyn’s (and others) were leaving the state in droves. There is no such thing as a guarantee of a perfect, healthy baby, especially when the mom is busy doing meth, not eating right and smoking and drinking during her pregnancy. But that won’t stop an ambulance chaser from driving her obgyn out of business if he can make a buck. And realize, tort reform in Texas by no means put the trial lawyers there out of business. ALL it did was limit NON ECONOMIC DAMAGES to $250K. “Economic” damages can still run into the millions of dollars, for instance if the baby now has cerebral palsy and the obgyn is on the hook for a lifetime of care.Report

              • Avatar greginak in reply to wardsmith says:

                Here is chart from originally from the CBO. We already have had a variety of tort reform in over half the states. And this is a state issue, that is where malpractice claims are heard.

                Tort Reform Since 1986 – By State
                2005 Tort Reform Summary > Tort Reform Since 1986 – By State

                Type of Reform Number
                of States
                Summary States That Have Enacted the Reform

                Modify Joint-and-Several Liability 38 States have based the amount for which a defendant can be held liable on the proportion of fault attributed, but the formulas differ substantially from state to state. In addition, most of the reforms apply to specific types of torts or have other restrictions. Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, South Dakota, Texas, Utah, Vermont, Washington, West Virginia, Wisconsin, Wyoming
                Modify the Collateral-Source Rule 25 Typical reforms either permit evidence of collateral-source payments to be admitted at trial, allow awards to plaintiffs to be offset by other payments, or both. Alabama, Alaska, Arizona, Colorado, Connecticut, Florida, Georgia,* Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas,* Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, New Jersey, New York, North Dakota, Ohio, Oklahoma, Oregon
                Limit Noneconomic Damages 23 The caps range from $250,000 to $750,000. More than half of the reforms apply to torts involving medical malpractice. Alabama,* Alaska, Colorado, Florida, Hawaii, Idaho, Illinois,* Kansas, Maryland, Michigan, Minnesota, Mississippi, Montana, Nevada, New Hampshire,* North Dakota, Ohio, Oklahoma, Oregon,* Texas, Washington,* West Virginia, Wisconsin
                Limit Punitive Damages 34 Various types of limits include outright bans; fixed dollar caps ranging from $250,000 to $10 million; and caps equal to a multiple of compensatory awards. Alabama, Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Illinois,* Indiana, Iowa, Kansas, Kentucky, Louisiana, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Texas, Utah, Virginia, Wisconsin


    • Avatar Mike Schilling in reply to Mark Thompson says:

      the single biggest cause of the cost problem by even further institutionalizing the tie between employment and health insurance.  

      The awful system under which my health insurance is negotiated by a professional who represents a big chunk of business to the insurer, rather than forcing me into the individual market, where every hangnail is a reason to deny coverage?Report

      • Nope.  The awful system under which the “customer” is divorced from the “consumer.”  Health insurers don’t need to care about whether they are doing a good job providing the services they are supposed to provide at a reasonable cost; they only need to care about whether the employers of those to whom they are providing services are happy.  Employers aren’t going to care, by and large, about much more than the portion of the health insurance costs that they are paying.  I also doubt the amount of leverage that the majority of employers have to get meaningfully better rates – really it’s only the huge behemoths that are able to do this.

        Besides, if we didn’t have everything tied so closely to employment, what would be out there to prevent individuals from going to a broker on their own who would then be able to use the collective weight of all his customers to get a better rate for them all.  Ultimately, tying it to employment just adds worthless layers of additional costs to the process which have nothing to do with the provision of care, all of which ultimately get paid for by the patient – the employer has its own costs to begin with, but then has to go through its own broker, who has his own costs and need to turn a profit, and then through the insurer.   And it should go without saying that the employer’s contribution to insurance costs ultimately comes out of wages, making that contribution little more than a nominal contribution.

        There is also an assumption that the individual market would be equally bad if employment and insurance were divorced.  But this is a baseless assumption that ignores the question of why the individual market generally sucks by most estimations.  It would seem that the individual market sucks in no small part because:

        1. With incentives as they are, it needs to offer insurance at a total rate that is cheaper than the post-employer subsidy rate paid by an employed consumer; and/or

        2.  It needs to offer insurance that the unemployed can afford, since the unemployed are going to be a primary customer base; and/or

        3.  Because of the employer/insurance tie (not to mention the whole no-insurance-across-state-lines issue), the individual market is artificially small and dispersed.  Combined with (1) and (2) above, this means that as it currently exists there is precious little consumer leverage to be found by consumers banding together.

        And all of this says nothing about perhaps the most pernicious effect of the employer-insurance tie: the preexisting conditions problem.

        A lot has been written over the years about the massive profits of health insurance companies.  I submit that the employer-insurance tie is the single biggest reason for that.  Even to the extent an employer really does want to get the best health insurance for its employees at the lowest cost to those employees (which is questionable in most instances), that loyalty is limited to the period that the employee will be working there, which will of course most likely coincide with the period when the employee is healthiest and comparatively less likely to require lots of expensive care.  The insurer gets to charge based on the assumption, more or less, that you’re going to have their insurance until you’re eligible for Medicare.  But in reality, you probably won’t, and there’s a decent chance that when you most need the insurance that you’ve paid for your whole life, you’re not going to have it anymore.

        But if we got rid of that employer-insurance tie, then individuals would have the leverage to pool together on their own to negotiate the best rates (or even have a professional negotiate the best rates on their behalf!) and/or the best policies.  They’d be able to spread their insurance costs out more evenly and predictably over time.  If the insurance company turned out to give them (not their employer, them!) crappy service, they’d have the freedom and ability to switch insurers, which provides one hell of an incentive for the insurers to provide less crappy service.   And the only way the preexisting conditions problem would come up would be when someone became sufficiently dissatisfied with their insurer to switch – in effect, their problem would be that they were unable to get less crappy insurance because of their preexisting condition, which is a far sight better problem than being unable to get coverage at all.


        • Bless you, Mark.  Nothing bothers me more than the pretense that our current health insurance problem is solely a market problem.  It is partly a market problem (there’s an issue of adverse selection, for example), but how the negative outcomes of such a regulated and bastardized system–particularly, as you note, one where the customer is not the consumer–can be treated as purely market-caused problems is an on-going case of bewilderment to me.

          It’s like saying our food prices are solely caused by the market.  The facts just don’t fit the conclusion.Report

          • Thanks, James.  The individual-employer tie has been one of my biggest soapbox issues since I first entered the blogosphere four or five years ago.  I think it may have even been the subject of my first ever post.

            And yeah, the adverse selection issue is no small issue.  There are ways to address it, of course, and it needs to be addressed in any system. It is also one reason why, ideological objections aside, it’s difficult for me to say that a single payer system (I remain vehemently opposed to nationalized care, however) wouldn’t be at least better than the existing perverted system, even if less than ideal.Report

        • Avatar Mike Schilling in reply to Mark Thompson says:

          <i> the employer has its own costs to begin with, but then has to go through its own broker, who has his own costs and need to turn a profit, and then through the insurer.   </i>

          Weren’t we told in the other thread that middlemen are a good thing?Report

    • Avatar Tom Van Dyke in reply to Mark Thompson says:

      MarkT,  I disagree with your premise, that “compromise” on socializing/universalizing health insurance is obligatory for good faith or duty.  The “a little bit pregnant” thing.

      There were plenty of alternatives to Obamacare that weren’t as global-comprehensive-ambitious, despite the prevailing narrative that it was Obamacare or bust.

      • Negotiation in good faith requires an actual negotiation, though, not a take it or leave it approach.  Bob Bennett got crucified and primaried largely because he committed the crime of attaching his name to a health care bill with a liberal.  The differences between the bill Bennett got crucified for and Coburn’s bill were, on the whole, pretty minor from an ideological perspective.  The liberal involved with that bill, on the other hand, was largely lionized on the left for it, and even managed to get some of the better ideas from it into PPACA, albeit on a too-limited scale to make enough of a difference for me.Report

        • Avatar Tom Van Dyke in reply to Mark Thompson says:

          MarkT, ’twas the Dems’ decades-old dream of nationalizing health care and nobody could stop them this time: They held the House, the presidency, and a filibuster-proof Senate. The only compromises they might have brooked would have been niggles around the edges. Otherwise, the GOP was invited to stay out.


          For the GOP, as Nigel Tufnel said making the finger sandwich, “But it’s this. And I don’t want this.”  Again, the “a little bit pregnant” thing.  How can you compromise on an absolute, like in this case, wrapping the not-so-invisible Federal Hand around the US health system?

          If you recall, we got stuck with the Senate bill, which was never designed to be the final version, just a step toward reconciling it with the House bill.  But Ted Kennedy died, the Massachusetts legislature re-changed the succession law to delay the seating of Republican Scott Brown, and the admin & Dems twisted House arms [Bart Stupak, pro-life Dems] to barely squeak the [very vague] Senate version through.


          There was nothing resembling consensus here, which I define on the back of the envelope as all of one party and some of the other.  Radical change such as this should not be forced by brute majoritarianism, as Obamacare was.  I cannot accept your premise that “compromise” on absolutes is possible.  I should probably come up with a better analogy than pregnancy or a finger sandwich, but you get the idea.



          • Avatar Patrick Cahalan in reply to Tom Van Dyke says:

            The problem with this narrative, Tom, is that PPACA looks an awful lot like what the GOP offered as universal health care back back in the 90s and made a lot of liberals really unhappy with what they got, as well (as evidenced by this thread if nothing else).

            I kinda have a hard time jibing this with “We got what the Democrats shoved down our throats” narrative.  Wouldn’t we have single-payer, universal Medicare if that’s what we got?  Why did we get this thing that not many Democrats actually like?

            That can’t *all* be due to tort lawyer lobbying.Report

            • Avatar Tom Van Dyke in reply to Patrick Cahalan says:

              Pat [&MarkT], I’m not up on the wonkage of previous GOP analogues to Obamacare.  But your and Mark’s argument must go here—if they were so great, the Dems should have joined the GOP and passed the damn things.  But they didn’t, and whatever you’re dumping on the GOP now applies to the Dems then too, and universalizing health care was their dream, not the GOP’s.

              Further, the people of Massachusetts elected a Republican to Ted Kennedy’s seat to try and halt it [and don’t give me that “Martha Coakley was bad” nonsense—they’d have elected Satan (D-Mass) if they wanted the bill.  In fact, he might have been an improvement on Teddy, but I digress].


              And further, even with the polls against it and the 2010 giving the GOP the House, the Dems are still going to keep the ratchet in place. So I won’t buy any protestations that the bill wasn’t rammed through, because the ramming and ratcheting continues.

              This bill stinks, with far too much left undefined and left to the discretion of the Sec of HHS.  I spent a day on it back when, and was appalled.  Re-litigating it is as useless as re-litigating Iraq, so let’s save ourselves the trouble.  I want the thing out, reversed, repealed; and when the Dems get their chance again—and they will—perhaps they’ll de-stankify it.Report

              • But your and Mark’s argument must go here—if they were so great, the Dems should have joined the GOP and passed the damn things.  But they didn’t, and whatever you’re dumping on the GOP now applies to the Dems then too, and universalizing health care was their dream, not the GOP’s.

                I think back then the idea was that this was bad, and they could do better.  Now it is (as again evidenced by this thread) : “Well, we have to do something and this is the best we can get, at least the GOP will go for this”… followed by surprise when they didn’t.

                I’m not absolving the Democrats here, Tom (look elsewhere for: “they screwed this up”).Report

              • Avatar Tom Van Dyke in reply to Pat Cahalan says:

                PatC: But it’s this, and I don’t want this.  Always consult the classics.

                I was not consulted on Wycliff-jean or whatever the bill was.  had i been, i’d say, let’s pump some more federal money into the county clinics instead, because in America—contrary to European popular belief—we don’t let our people die in the streets.


                [And if you want to compare our ad hoc county system to the NHS, it’ll come up rather well, based on discussions with my Eurofriends.  But that would be for another day, Pat.  We are so far away from reality on this one…]Report

            • Avatar Tom Van Dyke in reply to Patrick Cahalan says:

              & for the record, PatC, I think the torts thing is way overblown, although I gather it hits OB-GYNs pretty hard in premiums.  But I’d support some tax breaks for them rather than eviscerating torts.  Med professionals fuck up, sometimes royally.Report

          • Avatar Mark Thompson in reply to Tom Van Dyke says:

            Tom: I’m actually a little disappointed by this argument from you. Usually I find your counterarguments unusually challenging and/or thought-provoking, if not highly persuasive. This one just misses the boat, though. For all of the problems that there are with PPACA, “overly radical” is not one that really fits, seeing as the main premise behind it is to double down on the existing employer-based system. Yes, I know, the mandates, especially the individual mandate, but as Pat points out, the mandates aren’t anything Republicans hadn’t proposed themselves over the years, and in any event, the mandate here is absurdly weak, to the point of being pretty ineffective in all likelihood.

            Not least, you ignore my central point about the ideologically small differences between Wyden-Bennett and the Coburn bill, and how Bennett was crucified while Wyden was lionized. Indeed, read the Heritage Foundation’s original report on Wyden-Bennett and see just how close they came to supporting it before deciding that it was unacceptable, basically because it wasn’t quite as conservative as the Coburn bill.

            As I recall, the main objection was to the regulatory requirements of the W-B bill, which were largely to smooth the transition from employer based health insurance to individual based insurance, which is a pretty radical change, even though I might think it a necessary change.

            Which gets to my last point: the Coburn bill you linked to was far more radical than PPACA, and in fact would have fundamentally altered our health care system. This would have, in the long run, been a good thing, IMHO. I would have most likely preferred it to PPACA. But because it was radical, it needed to have a slow, well-regulated phase in if it was to avoid instituting mass chaos that would have undone a lot of its positive effects, if not all.

            In general, every time that liberals took a conservative idea and tried to incorporate it into HCR, conservatives suddenly disavowed the idea entirely and pretended to have always thought it a terrible thing. End of life counseling proposed by a conservative quickly became death panels; the mandates conservatives had supported for years became socialism ( hell, if I had the time to find it, I could even point to a comment from an archconservative friend of mine on my old site where he vocally advocated almost exactly PPACA in late summer 2007, placing special emphasis on mandates and reducing the costs of end of life care; by 2009, he was going to Tea Party rallies decrying the phenomenal socialism and anti-Americanism inherent in what would become PPACA.Report

            • Avatar Tom Van Dyke in reply to Mark Thompson says:

              Well, I’m sorry you’re disappointed, Mark.  The GOP-wonkage bills were still just proposals, really, never brought up for discussion and vote, were they?  Did some GOPers decide discretion was the better part of valor when the stank arose from the Obamacare bill?  No doubt.

              And no different from how Dems headed for the hills for Hillarycare, which never got near serious consideration or vote.

              I think my account of how Obamacare was rammed through is accurate: The Dems had their rare opening, and they were going to take it, and the GOP was not consulted.


              Fer crissakes, mark, even the Dems who voted for it didn’t know what’s in it.  Surely you remember that part!Report

    • Avatar Koz in reply to Mark Thompson says:

      “That wasn’t really a choice for liberals.”

      Why not? It seems to me to be a pretty easy choice for liberals if they had enough integrity.Report

      • Avatar Mark Thompson in reply to Koz says:

        To liberals, the number of uninsured was a higher priority than bending the cost curve (which was a priority, but less of one).  IOW, the problem they most desperately wanted to solve was the number of uninsured, and understandably so – the lack of insurance is an acute problem to an individual, while the rising cost curve is a cumulative problem.  The cost issue was related, and certainly one they wanted to address, but it was secondary, especially given that liberals (rightly) believe that the number of uninsured was a contributing factor to the cost issue.  Say what you will about PPACA, but it certainly reduces the number of uninsured.

        Of course, the opposite point is also true – the cost issue is a significant contributing factor to the number of uninsured.  And I personally think that it is/was a bigger problem than the number of uninsured.  But there’s also no objective way to prove which problem is bigger.

        If one’s operating assumption is that the number of uninsured is the most pressing problem, and PPACA addresses that problem, then there’s little honest reason to oppose PPACA.


        • Avatar Stillwater in reply to Mark Thompson says:

          If one’s operating assumption is that the number of uninsured is the most pressing problem, and PPACA addresses that problem, then there’s little honest reason to oppose PPACA.

          I’d also add that a solution to the cost curve problem is/would be a political solution, and the presupposition that this issue could be resolved more effectively by either stand-alone legislation or more directly in the actual bill, given the dysfunction of Congress, is a pipe dream. So it’s my contention that the cost curve was addressed to the highest degree possibly given the political context that exists today.Report

        • Avatar Koz in reply to Mark Thompson says:

          Yeah, I get all that but from a better angle the issue seems much simpler.

          I wanted to go to the Bon Jovi concert last Friday but Mommy and Daddy said no.Report

  21. Avatar Scott says:

    Nay, not constitutional.Report

  22. Avatar joey jo jo shabadoo jr. says:

    the same koz who projects that there are orders upon orders of magnitude of the true greatness of the gopers?  he’s just projecting again to play the victim.Report

  23. Avatar Maxwell James says:

    Yea. With major reservations, as all the other yea’s have expressed.

    My own particular reason for supporting it, despite everything, is that I’m quite negative about the future of our economy. I think un/underemployment will never get back to where it was before the crash, let alone the 1990’s. Which means that without the ACA, millions more people are going to be permanently uninsured or underinsured. I’m not okay with that.Report

  24. Avatar Robert Cheeks says:

    NO,  unconstitutional, and it’ll finish the job of wrecking the American economy so ably begun by our H-K Marxist president. We don’t need no stinkin’ commie-care.Report

  25. Avatar Stillwater says:

    Patrick, after reading the answers, I’m wondering if there’s some ambiguity in the question. Maybe a better question is “Do you think the ACA is better/worse alternative to the status quo?”

    I mean, there are any number of ways I could say that I vote ‘no’ on the ACA. But I do think it’s a significant improvement over what’s in place right now. Even your answer in the OP treats the issue as one of relative judgments between the actual bill and an ideal alternative: that the ACA is the wrong way to provide insurance for all (or whatever). So, for example, I both completely agree with that as well as still support the bill. Isn’t the issue whether each of us thinks the ACA in it’s entirely (not just according to one metric) better/worse than what we currently have?Report

    • Avatar Patrick Cahalan in reply to Stillwater says:

      Right now, I just want to see if it (as written) would pass with us voting.

      I have two contentions: the League is not significantly in favor of PPACA as enacted, and even those that do support it have reservations.  So far, this is borne out by the comment threads.

      I haven’t seen one unqualified “HELLS YES!” for PPACA.  I haven’t even seen particularly strong “Yea”s.

      Talking about whether or not it is better than the status quo is an alternate conversation, of course.  We can have that too, but it wasn’t the intention of the poll.Report

  26. Avatar Jason Kuznicki says:

    Against it.

    Two addenda:

    1.  Even supposing that it were constitutional, I’d still be against it.

    2.  This doesn’t mean that I thought the previous system was either perfect, or an instantiation of the free market, or both.  It was neither.Report

  27. Avatar Creon Critic says:

    Yea. Though my favored model is the UK’s National Health Service.Report

  28. Avatar Trumwill says:

    “Nay”. My opposition to it is/was soft, but had I been a member of congress I would have voted against it.Report

  29. Avatar E.D. Kain says:

    I just posted a poll asking the same question. Thought we should put it to an official vote.Report

  30. Avatar Alex Knapp says:

    Yay. Policy isn’t about what we’d want to do in an ideal world. It’s about the best politically feasible option that makes things better off than they would have been otherwise.

    PPACA was the best politically feasible option and better than the status quo it replaced. So if I had been in Congress, I’d’ve voted for it.Report

  31. Avatar DensityDuck says:


    And can we please, please stick to the original question?

    “Yes but I have some reservations–” That’s a No.

    “I’d pass it but I’d change–” That’s a No.

    “I think it’s the best we could get–” That’s a No.

    “It would have been better if they–” That’s a No.

    “I’d rather have seen–” That’s a No.

    “The Republicans–” That’s a No.

    “We had to do something–” That’s a No.

    “But no you don’t understand there’s a crisis and we had to do something dammit we had to do SOMETHING–” Yeah. No. See up there earlier where Patrick Cahalan says that there aren’t any unqualified Hell Yeah! for PPACA? The actual question asked is whether or not you’d give that. If not, then the answer to the actual question is “no”.

    Note that answering “No” is not the same thing as saying “there’s no problems with health care and no reason to fix anything about anything”.Report

    • Avatar Jesse Ewiak in reply to DensityDuck says:

      And as I said, if the only things that passed into law were things 270 (218+50+2) people all thought was the best possible bill, there’d be about five laws passed. Again, I don’t think I’d answer “hell yeah” to most bills that pass, even those I agree with. But I don’t let perfection be the enemy of good either.Report

    • Avatar Maxwell James in reply to DensityDuck says:

      Try reading again (emphasis mine):

      Regardless of whether or not you believe that PPACA is Constitutional or not (which is actually a major not-side topic on a goodly number of the HCR threads), do you support PPACA as enacted? If you don’t want to get wordy in the comments, a simply “yea” or “nay” will do for the purposes of this poll. If you don’t mind getting wordy, and changes could be made that would lead you to support it… what changes would have to be made for you to support it?

      There is nothing in there saying “only unqualified responses count.”Report

    • Avatar DarrenG in reply to DensityDuck says:

      Not at all true.

      I, like several others on this thread, don’t have a problem supporting a piece of legislation despite believing it is imperfect in various ways. The question wasn’t “is the PPACA your utopian ideal of health care reform?” it was “do you support the PPACA?”



      • Avatar Patrick Cahalan in reply to DarrenG says:

        Yes, this.

        I’m interested in everyone’s qualified opinions, of course, here in the comments.

        But the motivation is, “Would you have voted for it?”  I’ll edit that to make the post more clear.Report

        • Avatar DensityDuck in reply to Patrick Cahalan says:

          So your question is not “would you have voted for the PPACA as written”, but rather “would you have voted for healthcare reform”, which is a tremendously different question. It’s the difference between “would you have voted to authorize the Iraq War” and “do you think that it’s important to protect Americans from terrorism”.Report

          • Avatar Patrick Cahalan in reply to DensityDuck says:

            Both questions, actually.

            I’m interested, first of all, in how overwhelming the support is for PPACA as passed.  So that’s the “would you vote yes or no” part.

            Because my impression of all the HCR threads is that nobody was really super enthusiastic, whereas Koz seemed to come away thinking the League was more whole-hog for it.

            Secondly, I’m interested in what people would have voted *for*, if they wouldn’t have voted for PPACA… or, if they voted for PPACA, what they didn’t like about it anyway.


    • Avatar Ryan Bonneville in reply to DensityDuck says:

      Yeah, this is insane. Almost no legislation gets an unqualified yea from almost anyone. What a weird standard.Report

    • Avatar Koz in reply to DensityDuck says:

      Actually, I think your point is that all those responses are versions of yea.Report

      • Avatar DensityDuck in reply to Koz says:

        The original language of the post–“do you support PPACA as enacted?”–means that “yeah but” is the same as “no”.

        Now that it’s more like “would you have voted to pass Health Care Reform regardless of what the bill actually said”, “yeah but” is an acceptable answer again.Report

  32. Avatar b-psycho says:

    No, for the following reasons:

    -The mandate to buy a product that the proponents of the law themselves admitted sucks.  With even the minor release valve of a public government option removed, the mandate goes from heavy handed to straight up ridiculous.

    -The attempt to cushion the above with subsidies actually creates a new problem: you’ve just given the insurance “industry” a revenue stream guaranteed by the government. Profit motive + tax dollars = merciless screwing.

    -The size of the subsidies also pose a catch-22: if they’re too low they don’t actually help.  If they’re too generous, you might as well just cut out the middle man and directly pay for the care.

    -Many factors that helped make health care so expensive in the first place (allowing drug companies to extract monopoly rents from the results of tax-funded research, previous “reform” that restricted access to doctors, etcetera) are simply ignored.

    -Lastly, I have absolutely no faith in the ability of our political culture to successfully fight off calls to further regulate personal life wrapped in a cloak of fiscal concern.

    I had actually wrote extensively about the health reform fight at the time on my blog.  Anyone who wants more detail on my views on that is welcome to search.Report

  33. Avatar Burt Likko says:

    Constitutionally permissible given current commerce clause jurisprudence. If I were on the Supreme Court, knowing what I know now, I’d vote to uphold it.

    But I think it’s a bad policy idea, as certain to backfire as Wile E. Coyote’s latest mail-order shipment from Acme Co. If I had been in Congress when it came up for a vote, I’d have voted no.

    So I think that as framed, that makes me a “nay” on this question.Report

    • Avatar Jesse Ewiak in reply to Burt Likko says:

      As a side note, this leads to another interesting question. Let’s say next summer, the Supreme Court approves of the PPACA by a 6-3 or 7-2 vote. Do any prominent Republicans outside of the Bachmann fringe call for the impeachment of those ‘conservative’ Justices who turned their backs on them?Report

    • Avatar Tim Kowal in reply to Burt Likko says:


      Also, Burt, we must be a microcosm of the circuit opinions because I don’t think it’s constitutionally permissible.  Given the trajectory or momentum of the jurisprudence, sure, I get it.  But I’m of the mind that decisional law has to have some relation to the original text and meaning.  It’s not a game of telephone.  We were talking about eminent domain in another thread, and I mentioned that the Court no longer even bothers with the words in the original document, “public use.”  They’ve supplanted it in prior decisions with “public purpose.”  So was Kelo supported by jurisprudence.  Certainly.  Was it Constitutional?  Nope.  The jurisprudence lost its nexus to the document.Report

  34. Avatar Michael Cain says:


    Not because I support the status quo, but because this particular reform failed to address two points I haven’t seen mentioned here yet.  First, over the last few years, many CEOs of large companies in the US have publicly said, basically, that having to pay for employee health care makes a US plant uncompetitive with other developed countries, but their work force needs health care, even during times of unemployment, so… then can’t bring themselves to say “single payer”.  Second, anyone who says that we have to encourage entrepreneurs and small businesses to be job creation engines, particularly in tech fields, has to be in favor of some system where health care is separated from employment and what you pay is a function of what you earn.  I’ve known a large number of great tech people with good ideas who say either “I can’t afford to lose my group health insurance,” or “I can’t afford to spend what private health insurance costs during the three years when I’m living on my savings (or my spouse’s income alone) while we get the new business up and running and profitable.”Report

  35. Avatar Dan Miller says:

    I’m a yea, fwiw.  Not perfect, but better than what we had before.Report

  36. Avatar Renee says:

    Break should be brake … DuhReport

  37. Avatar Joecitizen says:

    Why is there so little discussed here about Individual mandate? Was this covered previously?

    Is it me, or does opening the door to allow government to dictate what services and goods we WILL purchase, a bad idea?

    Someone call time of death on citizen freedom. If its true that democracy fails via suicide I think we need a big body bag over here.Report

  38. Avatar James K says:

    I vote No.

    My opinion is that the PPACA* takes a bad system and makes it worse.

    1) Not only does it perpetuate the utter folly that is American “health insurance”, but the individual mandate effectively bans real insurance.

    2) It reinforces the link between employers and health insurance, a connection that makes no sense on any level.

    I see these as the central problems with your health care system, and any policy that fails to address them is at best useless.


    *BTW what is up with your long legislation names?  A good title has 3 words in it so it can be spoken in acronym easily, that’s why government agencies usually have 3-word names.  In New Zealand it would probably have been called the “Health Amendment Act”.Report