Tag: Healthcare

Death Spiral

It occurs to me that:

  1. The GOP categorically cannot resist getting behind bad policy with economically destructive end results, especially if and when they also increase suffering in the interim. It’s like their catnip.
  2. The Democrat wants to crawl out from under insurance reform with “popular” sub-measures, the community rating being among the very most popular.
  3. It is widely accepted that forcing a community rating in the absence of the individual mandate will extinguish health insurance as a profitable concern in this or any country

So here’s the plan. Figure out a way to pass the community rating. Fuck yeah, health insurance reform! Nobody can be denied coverage, 4EVA!!!!

Then: Healthy people stay out of insurance pools until they are genuinely sick, the insurance companies soon enough find they cannot continue to make money at that, prices and premiums spasmodically but systematically rise. Lather, rinse, repeat for 5-10 years. And then: BOOM. The system finally collapses utterly. President Palin is forced to do, uh, somethin’ or ‘nuther, doncha know? About all that health stuff and whatnot?

The GOP will have ushered in single payer.

And, no, I’ve not gone around the bend. Various conservatives are already making the connection:

the country will face a choice: allow the numbers of uninsured to continue shooting up, or enroll more and more people directly in taxpayer-funded government insurance plans.

I say, if nothing else, Democrats should be doing whatever possible to accelerate the arrival of that day. Think of it as the reverse Grover Norquist. And, rest assured, given the rampant fucktardia emanating from DC Democrats over the last few days, I think they are, uh, going as fast as they possibly can on this plan.

Pass. The. Damned. Bill.

Today’s installment of What Paul Krugman Said:

A message to House Democrats: This is your moment of truth. You can do the right thing and pass the Senate health care bill. Or you can look for an easy way out, make excuses and fail the test of history.

Tuesday’s Republican victory in the Massachusetts special election means that Democrats can’t send a modified health care bill back to the Senate. That’s a shame because the bill that would have emerged from House-Senate negotiations would have been better than the bill the Senate has already passed. But the Senate bill is much, much better than nothing. And all that has to happen to make it law is for the House to pass the same bill, and send it to President Obama’s desk.

[…]

[S]ome Democrats want to just give up on the whole thing. That would be an act of utter political folly. It wouldn’t protect Democrats from charges that they voted for “socialist” health care – remember, both houses of Congress have already passed reform. All it would do is solidify the public perception of Democrats as hapless and ineffectual.

And, let me just add: this asinine idea that you can chop the bill up into component parts is both functionally impossible and utterly improbable. So: the GOP is suddenly going to agree to operate in the best interests of the public? Since when? Seriously, when was the last incident of the GOP acting as though it had any responsibility re: actually governing. Name it. I’d seriously like to know. You could offer them full revocation of all taxes, closure of the IRS, and immediate shuttering of 85% of all government offices outside military and interstate highways and they’d still say: Hells No. Even better, from their entirely predictable point of view: the chop-it-up approach then ties up all legislative action for MONTHS as you serially run the mini-bills out for failed vote after failed vote after failed vote. All of which, of course, end in giant collective failure and a total lack of action on the things people are hopping mad about: the banks, Wall Street reforms, and jobs initiatives. Which, not coincidentally, are precisely the issues the Democrat could utterly crucify the 41-vote GOP with for the next eight or so months, right up until the 2010 mid-terms.They are AGAINST all of those things. And will vote to prove it. Unfortunately, they won’t be given the chance.

What part of the months-long slow-roll of the “negotiations” that went on from August to December of last year have the Democrats suddenly forgotten? The GOP wanted no part of compromise or some mythical “centrist” option. They DO NOT WANT TO PASS HEALTH REFORM OF ANY KIND, no matter what its shape, size, composition, font, paper quality, or decorative binding may be. Repeat: THE GOP is FUNDAMENTALLY and COMPLETELY against ANY REFORM. Full fucking stop.

Democrats, you’ve got two choices:

  1. Pass the fucking thing. You ALREADY DID. Those votes counted, you know. Pass, fail or abandon, those votes will hang around your necks like so many albatrosses. Better to have a useful outcome to point to than, you know, more months of utterly feckless failures.
  2. Pass a substantial expansion of Medicare and Medicaid, with Medicare buy-in over, say 45 or 50, paid for by some version of the Cadillac Tax on the wealthy. You know, what Ezra said. This would represent a substantial step forward, and can, without a doubt, go through reconciliation and would be a major fucking achievement that could start the day the bill was signed and, more importantly, people would actually like.

That’s it. Those are your choices. Why this is so fucking hard to understand after the display across the last 10 or more years up there is well and truly beyond me.

Fuck this up and it’s over. Democrats will be functionally out of power in 2010, totally out in 2012; Obama recalled as little more than Carter2. I’d say the odds for this outcome are pretty much 80/20 in favor of exactly that happening. If only the Democrat had a powerful leader with charisma and a strong public following. Somebody like that could take charge of this cluster fuck, start giving legislative marching orders, and navigate the turbulent political waters. But that guy has Rahm fucking Emanuel whispering in his ear. Odds go to at least 85/15.

Merry Christmas.

Re-conciliation

File under “Great Fucking Idea” from Ezra Klein:

Democrats could scrap the legislation and start over in the reconciliation process. But not to re-create the whole bill. If you go that route, you admit the whole thing seemed too opaque and complex and compromised. You also admit the limitations of the reconciliation process. So you make it real simple: Medicare buy-in between 50 and 65. Medicaid expands up to 200 percent of poverty with the federal government funding the whole of the expansion. Revenue comes from a surtax on the wealthy.

[…]

If health-care reform that preserves the private market is too complex and requires too many dirty deals with the existing industries, then cut both out. But get it done. Democrats have a couple of different options for passing health-care reform this year. But not passing health-care reform should not be seen as one of them.

And that’s it. Harry Reid walks out to the podium (with Nancy Pelosi maintaining a stately distance, naturally) and says: Fuck all y’all below the age of 50. Move to Massachusetts if you’re so fucking concerned with your fucking lack of health coverage. Go die in the streets and see if we fucking care. Rest assured: we do not fucking care. Not anymore. Coverage is for closers only. It’s the American Dream!

Instead, the Democrat will most likely commence to explaining why 50 votes can’t even be mustered even for this little change and the Democrat should sit quietly in a corner somewhere, execute only GOP-sourced initiatives discussed only using GOP talking-points and rhetorical frames, and otherwise do absolutely nothing between now and the 2010 midterms. Whatever you do, don’t rock the boat.

Don’t, under any circumstances, swing for the fences on bank and Wall Street reforms, jobs packages, and other such heady initiatives that force would the GOP to go along or (the vastly more likely possibility) just shut the whole government down for the next 8 months giving you, the Democrat, 24/7 talking points about how the GOP just loves them some Banksters and hates, hates, hates the common man and his/her ability to get a job. Whatever you do, don’t allow a Medicare buy-in such as the quoted paragraph suggests, because then you might have to repeatedly pummel your GOP opponents with why, exactly, are they so afraid of adding a little competition into the market. Why, exactly, they are so beholden to the concept of care costing 4-5x what it would cost in any other Western nation while delivering a fraction of the benefit with regard to outcome, as measured almost any way you want to look. Whatever you do, 59 vote majority, don’t start doing things. That way lies destruction.

But it’s also odd that Limbaugh would cite his experience in Hawaii as evidence that the U.S. health care system is “fine” seeing that Hawaii has already passed reform measures similar to those that Congress is currently considering as part of comprehensive reform — measures that Limbaugh has constantly been attacking.

Citing Experience In Hawaii, Limbaugh Says U.S. Health Care System Is ‘Just Dandy’ (via ryking).

So true. My recent voyage to Texas resulted in a similar experience: was asked how I expected I’d feel living under a mandate. Uh, we’ve had a mandate for TWO YEARS in Massachusetts. The information-free zone of FOXnews and talk radio is as poisonous as it is pervasive. Empirical reality: utterly beside the point.

One of the reasons I consider myself to be a progressive/liberal/whatever is because, more often than not, I’ve found progressives to be on the “right” side of the argument. They’re more empirical, more “scientific”, less dogmatic, less sophistic, less demagogic, less anti-intellectual – not always by any means but at least some majority of the time. After tangling with the [healthcare] kill-billers, however, I’m beginning to have my doubts.

Nate Silver, being absolutely goddamned right.

The Obama-Biden plan provides new affordable health insurance options by: (1) guaranteeing eligibility for all health insurance plans; (2) creating a National Health Insurance Exchange to help Americans and businesses purchase private health insurance; (3) providing new tax credits to families who can’t afford health insurance and to small businesses with a new Small Business Health Tax Credit; (4) requiring all large employers to contribute towards health coverage for their employees or towards the cost of the public plan; (5) requiring all children have health care coverage; (5) expanding eligibility for the Medicaid and SCHIP programs; and (6) allowing flexibility for state health reform plans.

The Obama-Biden campaign decidedly not promising single payer. Compare and contrast with the Senate bill. Shocking dishonesty, I know. Had Bush been allowed a third term, we’d be looking at this same kind of thing right now: 40 million people getting access to insurance.

This needs to stop

ryking:

“In 2003, a young Illinois state senator named Barack Obama told an AFL-CIO meeting, “I am a proponent of a single-payer universal healthcare program…” There was only one thing standing in the way, Obama said six years ago: “All of you know we might not get there immediately because first we have to take back the White House, we have to take back the Senate and we have to take back the House.”

This sort of gotcha line, utterly excerpted from its context is flatly ridiculous and, frankly, right out of the GOP playbook. Certainly has the ring of straight up PUMA-style astroturfing. Either way, it’s the typical, feckless DCCC circular firing squad stuff that the very same people screaming about it all claim to hate so much.

But wasn’t this Obama’s position? Didn’t he say it? Yes he did. Frequently. But it also matters what he always said next:

‘If you’re starting from scratch, then a single-payer system would probably make sense. But we’ve got all these legacy systems in place, and managing the transition, as well as adjusting the culture to a different system, would be difficult to pull off. So we may need a system that’s not so disruptive that people feel like suddenly what they’ve known for most of their lives is thrown by the wayside.’

He’s always said it that way during the campaign and after winning the election. I’ve never once heard him say it otherwise, or even with a particularly different wording. I’m quite sure if I could dig up the full text of the specific speech above, he said something like it then too. At any rate, here’s Obama directly addressing this quote back during the campaign. Notice what he says?

I don’t think we’re going to be able to eliminate employer coverage immediately. There’s going to be potentially some transition process. I can envision a decade out, or 15 years out, or 20 years out.

Hey, what do you know. That’s pretty much the way things are going. Start somewhere. Make improvements for 40 million uninsured in this country. Come back and fix the rest later. Move forward on the main substance.

It’s almost as if Obama campaigned on several issues, like focusing on the war in Afghanistan, improving health insurance, and, in sharp contrast to the Bush administration, actually bothering to hunt for bin Laden and shut down the various operational al Qaeda training facilities in various far-flung corners of the world (yes, even if that means putting a missile into Yemen). Now that he’s actually, you know, doing those things, various segments of the democratic party are shocked, shocked, and retiring to the nearest fainting couch or agitating that these things be undone. If you really feel this way, methinks you thought you were voting for Kucinich. Not that there’s anything wrong with that, but, honestly. What did you expect?

By all means, keep parroting the right-wing’s nonsense. Keep acting like poorly informed reactionaries. Just what they’re hoping for.

A message to progressives: By all means, hang Senator Joe Lieberman in effigy. Declare that you’re disappointed in and/or disgusted with President Obama. Demand a change in Senate rules that, combined with the Republican strategy of total obstructionism, are in the process of making America ungovernable.

But meanwhile, pass the health care bill.

Paul Krugman

No. I don’t want health care.

Senator Sam Bareback, er, Brownback, Republican of Kansas
Then why don’t we take it away from him? I’ve been agitating all along for a healthcare sunset provision on all Congressional insurance and/or Medicare coverage. If they love the market so much, let them go out and use it. We’d suddenly have a lot of focus on the issue once all those Viagra and Cialis prescriptions were getting paid for in full.