So now what?
So, setting aside whether or not one supports the public option or other counter-proposals for a moment, and just looking at the healthcare reform measures taking place right now, the question becomes – if there is no public option, and if current employer-based benefits are not taxed, then what on earth can we expect from the reforms? At this point it looks like maybe we can expect a mandate to have health insurance and to have businesses provide health insurance. This seems like a pretty bad step to take all by its lonesome.
For one, this may make some people purchase health insurance who are too “wealthy” to get on Medicare Medicaid, but who are also “poor” enough to make buying health insurance an either/or sort of decision. As in, I can buy health insurance or I can make a payment on my house; or, I can buy health insurance or I can buy food for my kids. A lot of these people will be employed by a very small business, or self-employed. They will ostensibly be middle class, but depending on cost-of-living and other factors that may or may not be true. Likely having to purchase insurance (or face fines and penalties) will end up benefiting insurance companies a great deal – most of whom operate as near-monopolies in many communities – but will hurt citizens and other industries. And I’m not at all sure that such a gutless reform will do anything to lower overall costs.
So what can we expect from reforms? And at how much cost? If a public option does not make it to the final bill, how satisfying would an expansion of Medicare and Medicaid be? At what point does the public plan just become Medicare Medicaid, or vice-versa? (And why do we need both, anyways?) And would liberals ever warm to a more conservative approach like the Wyden bill if the public plan in its current form doesn’t make it off the ground?
When you say “Medicare,” you mean Medicaid, correct? Medicare is for senior citizens, Medicaid is for the poor.Report
I think liberals want to see certain goals met like universal coverage, people with pre-existing conditions never being denied coverage and cost containment. The question is how to get there with so many entrenched stakeholders opposed to any meaningful reform. And with the “blue dog” dem’s hell bent doing the work of the republican party.
There will be a few more turns in the legislative process. We are far from seeing what sort of reform will actually pass.Report
“the “blue dog” dem’s hell bent doing the work of the republican party.”
Come on. At least *PRETEND* we’re in a representative democratic Republic. They’re doing the work of representing the false consciousnesses of their ideologically blinded constituents.Report
We are a representative democracy. The blue dogs are working at cross-purposes with the rest of their party and with their own stated desires. They want cost containment but are doing things to make it harder to contain costs. They are harming the chances for reform which is plank of the party they have benefited from and supported.
I don’t know if their consciousness is false or real. My consciousnessdar is sort of poor.Report
If the blue dogs are being called by their constituents saying “don’t you do none of that health care reform foolishness!!!”, are the representatives doing their job or not?
To put a finer point on it: Does (insert congresspeep here) work for the voters or does he work for (insert congresspeep’s party here)?
It seems obvious to me that the answer is the former. If you’d like to explain that, no, it’s the latter, I’d love to hear the explanation.Report
Well it is possible, just possible, that politicians do things to benefit the people who donate gigantic wads of $$$ to them. And they also have a duty to work on things that will help not make things worse. If their actions are creating a cluster then, that doesn’t seem to be a wise course. I also haven’t seen any proof that there are masses of constituents of the blue dogs that are saying “don’t do none health care”. In fact many of the BD’s have campaigned on improving/fixing health care.Report
Eh, I don’t know. The blue dogs are modern boll weevils. Socially conservative, arguably fiscally conservative. I think they’re representing their constituents in aggregate rather than doing stuff for Republicans… I mean, look at the 2008 returns again… do you really think that the Republicans have *THAT* much stroke???Report
Of course, since the public option is backed by like 70% of the public, presumably it is also strongly supported by the constituents of the Blue Dogs. I don’t have access to a lot of local polling, but the math doesn’t seem to work without a substantial number of rural folks also supporting it. In which case, the opposition of the Blue Dogs is contrary to their constituents’ wishes, their own stated goals (cost containment, which basically everyone agrees the public option could do at least somewhat), and their party. The only people they seem to be working for here are the insurance companies.Report
I’m with Greginak–we don’t know what the final product will be. This post from Yglesias closes with a useful quote: ““[alternatives being discussed by Baucus are] basically a terrible idea, but if it allows the bill to get out of Finance, it may have served a useful role.””
As for the Wyden bill: I’m sure you could get the Progressive Caucus on board if it was actually on the table, although I would disagree with your characterization of it as a more conservative approach. It may be true for your approach to conservatism, but I doubt it would command actual votes from conservative House members or conservative establishments.Report
I think it is a given that the republicans will not vote for any reform that actually changes much. The R’s are focused on stopping health reform.Report
Supposedly some R’s are on board for Wyden, but you’re right I think given their rhetoric we could assume they would peel off in a hurry if it became “the bill.” There are pretty much no House R’s and like 3 Senate who are even potentially interested in voting for a bill. That’s been demonstrated.Report
Um, I hate to be the one to point this out, but the Wyden bill has nothing to do with reforming health care or lowering costs. It is certainly “conservative” in that it will benefit business more than individuals. But, it has nothing to do with health care reform for individuals or families.
It reminds me of the graph in the Republican budget earlier this year, which in this case (Wyden’s bill) would be:
Force everyone to buy coverage + Subsidize the coverage of the poor by charging employers a small fee (i.e. a TAX) per employee = Healthcare costs are reduced!
To call the bill h*rsesh*t does a disservice to real h*rsesh*t. The bill does nothing to rein in costs or reform our current system, because the goal of the system is profit and no one in Congress (especially Wyden or Bennett) wants to change the system. Insurance companies make obscene amounts of money. They give obscene amounts of money to (mostly conservative) politicians in Congress. Congress makes sure not to change system – especially conservative politicians.
We will never get good healthcare, because that is not the goal. Profit is the goal. Without drastic changes (like a public option), we will not reduce health care costs. Profit is the goal.
I am reminded of Eisenhower’s Military-Industrial complex speech (sometimes, he seems to be the last sane conservative politician born in this country), particularly this part:
We’ve been in the “imbalance and frustration part” since Reagan (et al) started dismantling what was left of the “balance between the private and the public economy”. These past few decades have shown that conservatives (and many libertarians) only care about the private economy and want to “drown the public economy in a bathtub”. They have nearly succeeded.
Why do so many conservatives view “balance and progress” as EVIL? (Not that I’m saying anyone here views those things as evil, but you probably know some conservatives who do. Any insights from the conservative-inary gentlemen as to why this is such a major part of modern day conservatism/Republicanism/Limbaughism/Coulterism/Beckism/O’Reillyism/Palinism/Etc-ism?)Report
Ezra Klein concurs with my point above:
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Uhh….which point? Klein is one of the more outspoken proponents of the Wyden bill, calling it “the idea that could save health care reform.”
http://voices.washingtonpost.com/ezra-klein/2009/07/the_idea_that_could_save_healt.htmlReport
Uhh….the point about politicians being afraid to upset Big Business. The entire second half of my comment.
Wasn’t the quote from Ezra Klein obvious enough, Mr. Elenchus?Report
Well no one has ever claimed that politicians are afraid to upset Big Business. But to cite Klein in support of the proposition that the Wyden bill “has nothing to do with health care reform for individuals or families,” and/or is an example of politicians being afraid to upset Big Business doesn’t make sense when Klein is a vocal proponent of Wyden-Bennett. Wyden-Bennett would be, in a very real sense, a huge and significant reform of health care. Which is precisely why it has no chance.Report
I was citing Ezra Klein in support of the point I was making about Profit being the goal – and, not just the goal, but, THE ONLY GOAL. I thought quoting Eisenhower made that explicit, but I can see where that might not have been as explicit as I thought.
Ezra’s point about Wyden “not protect[ing] ourselves from health-care inflation” seems to be in direct agreement with my comment that Profit is the only goal and no one in Congress really wants to change that because of the consequences to political donations.
Regarding your proposition that it is incorrect (“doesn’t make sense”) to cite X (Ezra) about Z (Profit motive and health care costs) because X (Ezra) is for Y (Wyden-Bennett), I really don’t have anything to say.
Regarding Wyden-Bennett in ideal terms, Ezra is wrong. Regarding Wyden-Bennett in reality, I fear that Ezra is right – that it is the best thing this country is capable of. And, that’s really pathetic, if true.
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E. D., dude, I do have empathy for those kids who are in that grey area you described. However, I did call my Congressman and explained to his aide just how gov’t F**ked up medicine in America and we don’t need no stinkin’ Federali’s muckin’ around with medicine now! I also explained how that wacky boomer gen will go crazy the first time one of their wives dies waiting on gov’t health care. Some of them nasty old Nam vets are rough as cobbs!Report
Well, from what I’ve heard so far, the gray area may only expand under any proposed reforms. Sort of an “even the best laid plans” moment – or maybe a “good intentions pave the road” moment. Not sure yet.Report
So, what about our armed forces? They have government run healthcare (socialism!). Do their wives die while waiting on gov’t health care? Did they f**k up medicine in America?Report
I know a number of folks in the Air Force and a number of 20 year retired Air Force and, to a man, they all have private health insurance.
When I ask them about the free health insurance they could be getting instead, they shrug.
The plural of anecdote is, of course, not data. But I asked “what about our armed forces” to the armed forces guys I know and they’re all shelling out for insurance out of their own pockets.Report
Reform is dying on the vine. I was never for the ind.mand., but the subsidies do need to be mentioned in response to the concerns about hardships. HOWEVER, who’s to say the subsidies won’t still be substantially given away in the misguided effort to gain ‘bipartisanship’ for the bill as well? No one, that’s who.
I’ve argued there is a chance that the Wyden bill could be the fallback. Who knows. I still think the backlash against such a jarring change for so many more-or-less happily insured Americans makes that a non-starter. But it is a better approach, and you never know. I would question whether it is really a more ‘conservative’ approach. It’s certainly more radical. Yglesias had an interesting post yesterday pointing out that the benefits exclusion is actually an extremely regressive tax policy — so its cancellation could be seen as more progressive in tax impact, therefore more liberal in crude political terms.Report
“I’ve argued there is a chance that the Wyden bill could be the fallback. Who knows.” I don’t share your optimism, but this is one thing on which I hope I’m wrong.
I also think you’re right that Wyden’s approach is more radical than conservative. I think it’s far more libertarian-friendly but libertarian and conservative are not synonymous.
Also – that’s an interesting point about the regressivity of the existing exclusion. I hadn’t thought about that before. That’s the sort of thing that would tend to be viewed as good policy by both liberals and libertarians, methinks.
Still, you’re right that more than anything the Wyden proposal is more liberal ideal than traditional conservative ideal. It’s also more liberal ideal than libertarian ideal because of the heavier regulation of the individual market (combined, perhaps, with the inclusion of the public option in the current version). But those differences aside, it’s the sort of thing that ought to be more palatable to libertarians than the status quo.Report
The only thing that makes it less preferrable for me is that it’s not going to happen. By which I mean there’s maybe a 2% chance it could become the fallback, at which point it would be rejected as an ‘inferior’ second option. 0% (well, maybe 0.01%) that it would become law. (So we’re not that far apart on that I don’t think.)
One thing’s for sure: an idealized Wyden (ie pre-negotiations) certainly looks better than the mangled heap that appears to be emerging now.Report
O/T: How about Brett Favre? Took guts to make the right decision in my view, even if it took him a while.Report
so how long until he starts talking about playing again?Report
I’m going to guess that he’ll spend the next two years doing what Clemens did at the end – sit the first 1/3 of the season out, then sign up somewhere for a boatload of money to help with the playoff push, then go back into temporary retirement again.
I’m probably wrong, though.Report
An interesting thought, except that there’s already a different pitcher every game, so it doesn’t affect the flow/chemistry whatever any more than is already the case. You want to keep some consistency at QB usually, although there are certianly times where a team has to change QBs a lot. But it’s sub-optimal. If the Vikings tried that, I think Minnesotans would say, “You know what, go ahead and move to L.A. We could care less.”Report
You’re right, of course. Still, there’s almost always a team that’s on the edge of the playoff race with a gaping hole at QB, either due to an injury or due to having no good options at the spot. The likelihood of my prediction being right? I’m going with p<.20. But if it turns out I'm right......then I'd qualify as a guru of sports prognostication. I figure if I make enough outlandish predictions, one will eventually come true, and I'll get to take credit!Report
I think Greg may be more on the moark raising the question of whether he might wait a full year for the body to recover, and then join his Minnesota coterie now relocated in L.A., sort of as a novelty kick-off attraction for the new venture, before actual attmepts at contention begin in earnest. But who knows, you could be right… and Wydenesque health reform could become law by the end of the year! (Insert nutso tongue-wagging emoticon here.)Report
That is my guess.Report
Either one month or forever. Seriously, though, Minnesota is where he’s wanted to be for years. If he couldn’t make it happen there now, I don’t think it’s going to happen. But maybe a year off to heal the body is just what the doctor ordered, if the offer still stands next year (which would be pathetic).Report
It’s good to see that people here are accepting that government is incapable of creating viable healthcare reform through central planning.Report
Because Lord knows this forum wasn’t at all predisposed to that view to begin with. I realize it’s snark, but you’re obviously overreading the acknowledgement — not a new or isolated one from those inclined to support government efforts to address the medical crisis (I know, I know, there isn’t one) — that this happens to be flawed legislation.Report
I’m overreading? Then you think they will correct the flaws?Report
No, of course not, but that proves nothing about whether government could institute policies that would do some good. I suppose your out could be “by central planning.” That sounded like an undefined term of derision for government action to me, but perhaps you have a specific definition for that, which if the government were to avoid you would conede it could in theory address the problem.
Your comment seemed to say that because this particular effort seems to be turning out to be quite troubled, that everyone here who advocated a government-led effort has conceded that any such effort is doomed to failure. That’s not the case.Report
Of course “fix the problems” is also an entirely relative term.Report
E.D., a minor point: plenty of liberals (including Ezra Klein and little old me) are plenty warm to the Wyden-Bennett plan. I don’t think it represents a complete solution, but I do think it would be a major step toward unwinding some of the most serious distortions in health care policy (#1 is the employer tax exemption). I would hail Wyden-Bennett as a MAJOR success.Report
So (I think) would Mark Thompson. But we’ve agreed it’s about as likely as Brett Favre unretiring ten games into this coming season. Ain’t gonna happen.Report
Fair enough. I think there is a definite problem in the leadership, not in the majority of Americans (lib, con, or what-have-you). I would really like to see something like the Wyden bill take center stage as it has real merits. Doubtless the hacks and partisans in the conservative movement would attempt to torpedo it, of course, but at least it would stand a better chance at broader support.
Anybody seen the Netherlands model of health care, by the way? Just about the freest market solution out there right now and consistently ranking at the top of the European health care performance ratings.
I think I’ll dreg up some data and do a post on it, but it’s pretty neat.Report
I think there are lots of interesting models we could look at, but it’s worth nothing that health insurance in the Netherlands is still compulsory, heavily subsidized, and (in the case of long-term care) substantially covered by the state. According to my quick look at Wikipedia just now, the estimate is that 62% of total health care in the Netherlands is paid for by the government. Even in these kinds of market-based systems, government involvement is very, very nontrivial.Report
I think there’s a difference between the amount of the government subsidy and the amount of government involvement, though. As it is, US government spending on health care is already incredibly high, ranking in the top 10 in the world and accounting for at least 45% of US health care expenditures (and I believe that doesn’t include the offsets from employer tax incentives). Health care in 2004 was also 22% of total government expenditures, which is behind only Andorra, Haiti, Nauru, and Liberia.
The more I look at this subject, the more I’m convinced that the difference between the US system and the rest of the world isn’t that we have too small of a safety net, it’s that the way in which that safety net is structured is just totally f’d up. We really ought to be able to completely reform our health care system without increasing governmen subsidies by one penny. In many ways, I am even beginning to think that our government is more involved (in the sense of the scope of its powers) in the health care market than the vast majority of other countries.Report
Yglesias mentioned the Dutch this morning as well, in a post that I thought appropriately overstated the case at well-chosen moments:
http://yglesias.thinkprogress.org/archives/2009/07/change-but-not-too-much-of-it.phpReport
E.D. – have you looked much into the Swiss system? If not, you should. If so, then disregard this.Report
BREAKING!! Double-barreled assault in primary national political organ by center-left columnists on HR3200, unified in favor of Wyden health approach.
http://www.washingtonpost.com/wp-dyn/content/article/2009/07/28/AR2009072802112.html?hpid=opinionsbox1
http://www.washingtonpost.com/wp-dyn/content/article/2009/07/28/AR2009072802114.html?hpid=opinionsbox1
Tide turning in Washington health reform thinking?Report
My comment is awaiting moderation. Many of my comments (less so here) wait a long time indeed for moderation.Report
I’m going to try to post again. I think something might be up.Report