34 thoughts on “In the Wake of the Mass Massacre—Bipartisan Reform or the Senate Bill ?”

1. Maggie – My perception of the mood of the electorate differs somewhat from what you’ve written. In poll after recent poll nationwide, the respondents have demonstrated majority disapproval of the proposed legislation. Their disapproval in part reflects propaganda efforts by reform opponents who have disproportionately emphasized flaws in the legislation and the legislative process without acknowledging the virtues or the urgent need for reform. The public resistance goes beyond those misperceptions, however, and reflects some public anxieties that can’t be attributed exclusively to misinformation.
   I agree with the views expressed by you, by the experts in the letter you quote, and by many others that ultimately, we cannot afford to refrain from the types of reform that would begin with the proposed legislation. In the short run, however, the proposed reforms clearly benefit only a minority of Americans. Some are middle income individuals with particular vulnerabilities, but more are among the lower income members of society, and do little for the majority in the middle class except expose them to the vague risk of higher taxes and other uncertainties during a deep recession that has all of them fearful about their future. The long term benefits would be far more extensive for our entire society, but to ask an anxious electorate to look that far into the future is to expect too much.
   I’ve already telephoned the office of my Congressman, urging him to pass the Senate version so that its flaws can be fixed later, but given the public mood, I’m not optimistic. We may have to proceed with short term increments for the present, and pursue the heart of reform – adequate and affordable universal coverage – when the economy improves, hoping we will still have a majority in Congress sympathetic to that principle.
   In the meanwhile, it’s tempting to blame our elected representatives and our president for mismanaging the reform effort, and indeed, there have been missteps. We should refrain, though, from intemperate attempts to punish the reformers in Congress and the Administration, and ready to work with them for however long it takes.
   For perspective on this point, I’ll take the liberty of quoting from my own comments on a TPM blog earlier today –
   “The Democrats came close – ever so close – to putting one over on the public. They cleverly touted healthcare reform as a benefit to the middle class, when in fact, it was a sneaky attempt to help the poor, the disadvantaged, the famililies forced to choose between health and food, the infant who dies because prenatal care was not there for her mother, the worker permanently disabled by a stroke because his high blood pressure was never treated.
   They tried to push through altruism and a sense of community disguised as selfishness, and they got caught. They are likely to think twice before trying that ruse again.
   But beyond their own flawed philosophy, and beyond their own clumsy and at times disgraceful attempts to placate innumerable special interests on the way to their goal, they were also the victims of two pieces of bad luck. One came from George Bush and the other from God.
   The healthcare plans were formulated as part of the Obama campaign, but when Obama took office, he faced an economy on the brink of collapse – a circumstance not envisaged in the original planning. Perhaps the planning should subsequently have accomodated itself to that reality, but the reality itself was an unlucky legacy of the Bush administration, and not something Obama can be faulted for.
   As for the other blow dealt by the winds of misfortune, blame God.
   If Ted Kennedy had not died 5 months ago, these blogs would read very differently today. Think of the admiration that might have resounded throughout the media and much of the blogosphere for a fledgling Administration that maneuvered into law one of the great triumphs in the history of American social change.
   And yet, that admiration would have been bestowed on a president and Congress that did just what it has done.
   Before venting too much legitimate anger on the wrong targets, think on it.”

2. Fred: Aside from your analogies at the end, which are a bit of a stretch, I liked your post. And, Brown could have lost to the same spread that he won by and it would have caused the same result in Congress!

3. Those polls show it wasn’t a referendum on healthcare. The election proves though, that if there are single issue voters that support healthcare reform out there, it’s not enough to get you elected. Otherwise Reid would be swearing in Senator Coakley. There should have been little doubt in the minds of those that elected Scott Brown what the result was going to be. He ran on killing the bill and being the 41st vote. He made that abundantly clear. So the 51% either liked that position or it wasn’t important enough an issue for them not to vote for him and they had other motivations.

   • The abtiliy to think like that shows you’re an expert

4. this isn’t rocket science. Pelosi doesn’t have the votes. Incumbents who get re-elected have a good sense of the public pulse and many have concluded that the Mass. result is not an anomoly and that voting for a big package — House or Senate iteration — will cost them votes. People like the experts you cite cannot deliver any votes for them. Polls seem to show a majority of Americans have doubts about these plans. Telling a majority of your voters you voted for a plan they distrust because the experts said it was good is not a good re-election strategy.

5. I live in Mass. and firmly believe there are better outcomes that could come to pass from this fiasco other than the limited view of “a (crappy) Bipartisan bill or the Senate bill”
   Jim is onto something very important when he concludes “Telling a majority of your voters you voted for a plan they distrust because the experts said it was good is not a good re-election strategy.”
   I’m one of the 60-70% of voters who support a “robust” public option in health reform. We want it in the bill!! We see it as an incremental step toward fuller reform of our broken system. The majority of voters recognize the cost-saving value of creating a large public insurer. This could really make inroads to rein in the abuses of both the profit-driven insurance industry and of money-driven medical practice. Obama campaigned on the public option for these reasons and the voters liked it, for heavens sake!
   Many, many Americans who are under 65 want the option to NOT have our healthcare dollars run through a private insurance company. And those of us who understand healthcare system issues welcome the opportunity for government to use evidence-based research and solid public health programming to spend healthcare dollars more frugally while promoting health more effectively. This can be done with a robust public insurer, building on similar projects ongoing within the Medicare program.
   I predict there will be a demand for reform that tackles cost-control head on. Yes, the public has a deep desire to see improvements in the economy, in jobs, in international relations. Yet there’s also a yearning for a healhtcare bill that takes on the special interests and focuses on a more cost-effective model for providing comprehensive affordable health insurance for all. A robust public option along with new rules to prohibit the worst abuses of private insurers is a start. Another scenario is that, riding the popularity of the public option, a few brave politicians could start a wave of populist support for an improved Medicare-for-All who want it.

6. Why not craft a healthcare reform bill that would be widely supported by the voters? Forget whether they are republican or democrats or who wins in DC.
   If the legislation is supported by the people, the politicians will not vote against it.
   I read that the public option has 60-70% support, lets simply call it “Open Medicare.”
   If someone has access to polling data on healthcare issues, this should be easy to do.

7. For the fools who believe there is some alternative that can be worked out with the Repubs and the healthcare and healthcare insurance insustry, I would tell you this is the last chance for the next decade. Pass the Senate bill that resides in the House

8. What color is the sky in Mahar’s world? Hilarious. It’s over. Everyone knows that. Or almost everyone.

9. I have zero faith in Doctors especially the establishment ones in the list above. Will the author please provide the data about how many of these belong to AMA. I bet that will be a majority probably a super super majority. AMA is the most shameless organization which represents the Shylockian Doctors who want their payments to increase irrespective of the Economy being in the toilet and public suffering. I provide two links below. First on the responsibility of all the stake holders especially the supposed to be Noble Physicians. Second on the evidence of shameless behavior of AMA. If there is truth here, asking these Physicians to decide how to lower the costs to make health care affordable without shoving their hands in the taxpayer’s till, is like handing the hen-house to the Fox.
   http://tinyurl.com/HCproviderRole
   http://tinyurl.com/moremoney4docs
   If only these guys took the suggestions of the Progressive Base seriously, setting their personal interests aside, they will do President and the country some good.
   http://tinyurl.com/CollInsanity

10. doubleaseven —
    Almost none of the people who signed the message regarding the health care bill belong to the AMA since almost none of them are medical doctors.
    They are academics with specialities in health care related issues. For the most part they are political scientists, sociologists, economists, and so on.
    If you want to know exactly, you can google any name on the list, since they all are very active in publishing and speaking about health care issues.
    The AMA is poorly understood by lay people, but has relatively little power in the health care industry or in medicine. A large majority of doctors do not belong to it. It is essentially a club, with most of its power coming from its popular and widely quoted journal, JAMA — the Journal of the American Medical Association — which largely is independent of the club part of the AMA.
    The various specialty organizations, the hospital organizations, and the hospital certification boards have way more power.
    However, “the AMA” is often used by uninformed people as a convenient shorthand for what might be called, taking a page from the famous military/industrial complex, the “medical, pharmalogical, device and equipment manufacturers, insurance, bonding, and hospital complex.” The AMA is a weak sideshow, but the MPDEMIBH has a lot of power, albeit divided among its various subgroups.
    It’s just a mouthful to talk about.

11. Relevant to future prospects for success of a reform package similar to what is proposed, but with possible modifications, is a very recent Kaiser Foundation poll –
    http://www.kff.org/kaiserpolls/upload/8042-F.pdf
    The results show that the nation favors healthcare reform in principle, and is about evenly divided on the current proposals, but with opposition characterized by greater intensity than support, which is unenthusiastic on the part of many respondents. Most of the individual provisions are supported, whereas opposition relates primarily to the mandate and to the estimated cost of reform, with the latter opposition based on the frequent misperception that the reform package would increase the deficit.
    In aggregate, the results suggest that the proposed reforms might garner net public support by emphasizing their potential to reduce the deficit. Although the mandate is critical to other elements of reform, it could be tweaked, perhaps, in ways that reduce its negative effects on public opinion.
    I wonder whether President Obama, in his State of the Union speech, might not be able to facilitate the effort to increase both public understanding and public support for the reform effort.

12. Ann, Fred (your most recent comment on Kaiser poll) and Fred (your first comment)
    Ann — Unfortunately, the citizens of Massachusetts decided that they liked Brown. (New exit polling information tells us that they were indeed voting on personality and good looks, not trying to send a “message” to Washington.
    An exit poll by Hart
    Reserach shows who voted for Brown: the working class. The vote split deeply along class lines:
    (This poll has a margin of error of +- 3.8 percentage points.)
    —Coakley won this election by five points among college graduates, but lost the
    non-college vote by a 20-point margin. This represents a huge swing among
    non-college voters since 2008, when Obama won by 21 points, for a net swing
    of 41 points. (
    –
    Non-college men voted for Brown by a 27-point margin (59% to 32%), and
    non-college women also voted for Brown by 13 points (while college women
    went for Coakley by 13 points)
    .
    –Gender dynamics were less important than the class dimension: the 15-point
    gender gap (men voted for Brown by 13 points, women voted for Coakley by
    two points) was actually considerably smaller than the 24-point gap in 2008.
    Insofar as these voters are concerned about the issues, jobs came first–not health reform.
    Because Brown won, Senate Democrats are left with 59 votes–at best. . .
    That’s the simple fact.
    IMHO the voters of Massachustts were extraordinarily foolish (as were the voters of Ct. when they re-elected Joe Lieberman).
    Those two sets of voters did more to block reform than anyone else.
    In Mass. the Democrats had a wide lead on Jan. 1. As
    their candidate proceeded to put her foot in her mouth they should have seen what was going on -and ACTED.
    Voters in inner cities and traditional Democratic strong-holds did not come out in force. The Democrats needed minority voters –these are the non-college voters who elected Obama — and who would not have found Brown’s frat-boy charm appealing.
    But Democratic organizers in Mass woke up too late.
    The fact that you and I and most of our friends want the public option means little.
    We dont’ have the votes in the Senate to make that happen.
    Lieberman won’t vote for it. Brown won’t vote for it. And no Republican will vote for it.
    These are the respresenatives the American people have elected.
    Ann, you say that the majority of American people want the public option.
    The fact is that the majority of the American people Don’t Know What the Public Option Is.
    Kaiser just released a poll, done in Janauary, which shows that most Americans have little idea what is in the health reform bill. For isntance, 63 percent didn’t know that under refrom, people could no longer be denied coverage because of pre-existing conditions. When they were given this information they said they felt better about reform.
    The vast majority had never heard of the insurance exchanges.
    They weren’t asked about the public option because it is no longer in the legislation, but you can be sure they also don’t know what it is.
    Ann, this is the bottom line: college-educated progressives such as you and I do not represent the majority of the American people.
    The majority of the people either dont’ have a clue what health care reform is about (and dont’ have the time,, interest or in many cases the ability to take in the informartion) AND/OR
    they have their own employer-based insurance and are opposed to reform because because they suspect that eventually it will cost them something.
    They definitely do not undertand how a public option would raise the bar for insurance companies.
    Sorry to be so repetitive, but this is all so frustrating. . .
    Fred– regarding your most recent comment on the Kaiser poll.
    Yes, I read it– see my reply to Ann above.
    What is most striking is not what it shows about suppport for reform or opposition to reform, but that most people have no idea what is actually in the reform bill.
    Most seniors, for instance, don’t know that it closes the donout hole.
    Could President Obama get the public to understand this legisation in his STate of the Union speech?
    Fred, I hate to say this, but most Americans cannot find their own home on a
    map. We have not done a very good job with public education in this country, and we put a higher priority on good looks, charm etc. than intelligence or the ability to think rationally. (Hence, we elect Brown and came frighteningly close to electing Palin V.P.)
    Health care legislaiton is complicated–and must be complicated– because as Paul Krugman keeps pointing out, the pieces depend on each other.
    You can’t tell insurers that they must insure people with pre-existing conditions unless you have an individual mandate.
    You can’t have a mandate–and tell people they must buy insurance–unless you have subsidies so that they can afford it. You can’t have subsidies unless you have some way of financing those subsidies–a “Cadillac tax”, a tax on those earning over $500,000 or whatever.) I could go on: one detail leads to the next.
    For example: You have to raise fees for primary care and provide scholarships for med students or you won’t have enough docs to provide care for all of the uninsured once they have insurance.
    This is why the bill is so long.
    Could Obama explain much of it in a 50-minute speech to well-educated “Americans who were willing to listen–and weren’t confused by all of the misinformatoin and outright lies that have been pread. Yes, I think he could.
    But the well-educated Americans willing and able to digets complex arguments do not represent the majroity of Americans.
    See my reply to Ann above: Brown was elected, overwhelmingly, bu voters who don’t have a college education.
    Now there are many smart people out there who don’t have a college education– I know quite a few of tehm.
    But by and large if you look at very large groups, education tends to be a marker for ability and willingness to listen to long, complciated speeches.
    Fred–in response to your first comment Jan 22 5:24
    Yes, if Ted Kennedy hadn’t died, we would probably have reform in a week or two.
    More importantly, if the voters of CT hadn’t re-elected Joe Liebeman, we would have heatlh reform now.
    In many ways, the voters have themselves to blame. We get the government we elect.
    But that’s water under the bridge.
    Right now our leaders must LEAD. Just as with civil rights legislation, we need strong, determined leadership in Washington, despite opposition to health care reform among the public –opposition grounded in misinformation, as you say, as well as complete ignorance as to what is actually in the legislation. (See my reply to ann.)
    I remember teh days of civil rights legislstion and the heated opposition, not just in the South, but where I lived in Syrancuse N.Y. But it had to be done. Either that, or watch our cities burn. (Syracuse was on fire more than once–people forget all of this. Today, the poor are so passive. But then, they were angry.)
    I agree with your analysis that the majority of middle-class, uppper-middle class and uppper-class Americans not benefit from the health reform bill because they already have employer-based insurance.
    And the majority of Americans simply are not that interested in low-income Americans, or vulunerable Americans who suffering from pre-existing conditions.
    (Though I would not call the progressive appeal to altruism a “ruse”. We must begin to think ocllectively, or othis society–and this economy–will fall apart, as I explain below.)
    But unfortunately, at this time, most people it this country think only in terms of “me and my family”–not the collective good.
    Perhaps it will take economic catastrophe–something worse than the Great Depression–to bring us together.
    What most Americans don’t understand is that our broken health care system encourages spiraling health care inflation: without reform the cost of care will continue to go up 8% a year for the foreseeable future.
    This is the single greatest threat to the American economy–and will effect all of us.
    The 47 experts who signed the letter understand this. They are, as Pat points out, health care economist, policy experts, etc. They understand the economis of reform.
    They understand that this reform legislation is a first step toward the government beginning to take control of health care spending and putting a lid on health care inflation by changing what we pay for, how we pay for it, how much we pay for it, and how health care is delivered.
    Most Americans don’t understand global finance – and how rising health care costs threaten the economy—but these are the facts: as health care costs rise, our deficit will rise (the Government now pays more than 50% of the $2.6 trillion we spend on health care–this includes the money the govt spends on health insurance for govt workers.)
    As our deficit rises, world-wide faith in the dollar sinks.
    Gold is already trading well over $1,000. This is a sure sign that foreign investors and Central Banks are buying gold because they no longer trust the dollar. The dollar is only paper–with nothing behind it. (It used to be backed with gold.)
    As the dollar falls in value, at some point the coutries that produce oil will begin pricing it in some other currency–not in dollars.
    This means energy will become more and more expensive for us.
    Teh weaker dollar also means that all of hte goods that we import become more expensive.
    Finally, right now foreign investors own the bulk of our debit–they own most of our Treasuries. As they lose faith in the solidity of the U.S. economy, they will stop buying our Treasuries unless the Fed raises interst rates.
    HIgher interst rates means that mortgages are less affordable, businesses cannot afford to borrow, expand and hire . . .
    The result: more unemployment, and widespread inflation.
    Unless we do something about the deficit–which means unless we rein in health cear inflation– we can expect standards of living in the U.S. to fall in the foreseeable future.
    I realize that this is all too complicated and sounds too apocalyptic for most non-economists to understand. But it is the fact.
    This is one reason why people like Paul Krugman are saying that we Must pass teh Senate bill.
    (The other reason is that it will provide coverage to millions of people who don’t have health care today.)
    You write: “We may have to proceed with short term increments for the present, and pursue the heart of reform – adequate and affordable universal coverage – when the economy improves, hoping we will still have a majority in Congress sympathetic to that principle.”
    The economy is not going to improve unless we make some drastic structural changes. This is not what is called a cyclical recession (respnding to business cycles) this is a secular recession (responding to deep structural problems in the econommy. George Bush dug a very deep hole.)
    As White House budget director Peter Orszag keeps telling us, health care inflation is the biggest threat to our economy–and in the end, that is going to affect all of us, whether or not we have health insurance.

13. Henry, Jenga, Jim, Ed, run 75441, they won’t listen, doubleaseven, Pat
    Henry– I liked Fred’s comment too. Except I don’t think that it’s a “ruse” when liberall Senators try to appeal to our altruism. People like Jay Rockefeller and TEd Kennedy are/were genuinely altrustic.
    And yes, if Kennedy hadn’t died we would have health care reform in a few weeks–
    Jenga– See my reply to Ann on the exit polling.
    Health care just wasn’t that important to the working-class folks who voted for Brown.
    Jim–
    I like to think that many Congresmen would vote for or against something of this importance without making the decision based on “How will this affect ME when I run for re-election.)”
    As Paul Krugman put it in his most recent column:
    ” politics is supposed to be about achieving something more than your own re-election. America desperately needs health care reform; it would be a betrayal of trust if Democrats fold simply because they hope (wrongly) that this would slightly reduce their losses in the midterm elections.”
    IF Democrats don’t manage to pass something pretty close to the Senate bill they can forget about being re-elected. They will have shown that they can’t govern.
    Many of them won’t be re-elected next time around anyway–because of the economy, and because it’s two years after the election of a new president.
    They might try to do something useful before they leave town.
    I have quite a bit of faith in Pelosi–if Obama gives her the green light.
    She’s an old-time politician’s daughter and a fighter. She has done surprisngly well up to this point. I think she’s able to “roll over” enough legislators (Gringirch’s phrase to get the fotes if she has to. I just wish Hillary were in the Senate to help her.
    But perhaps, behind the scenes, Hillary can help. She got along surprisingly well in the Senate and has many supporters there.
    Ed– The public doesn’t know what it wants because most don’t know what’s in the legislation or what reform would do.
    See my reply to Ann, and my reply to Fred’s most recent comment.
    run75441–
    Yes, thank you. This is what they must do. I’m not certain they’ll pull it off, but they must do everything possible . . . And as I mentioned to Jim, I do admire Pelose’s fighting spirit. If Obama gives her the go-ahead, she might pull it off.
    theywon’t listen–
    I hope you’ll find it just as hilarious when you find yourself living in a country where your standard of living has fallen sharply . . . (see my reply to Fred’s first comment)
    doubleaseven–
    See Pat S.’s comment right above yours. He is correct.
    Pat. S. thanks for straightening this out.
    You’re right about the ” “medical, pharmalogical, device and equipment manufacturers, insurance, bonding, and hospital complex.”
    They are the ones with the power.

14. I never thought health care reform could be a reality last year but somehow as time went by it seemed possible and now it is starting to feel like it is impossible again… as a commoner I feel it needs to be done but the odds are against it. Medicare and social security passed because there was no cable media, no internet, no blogs, for some reason bad news, lies, ‘death panels’ travel’ faster faster than the truth and common people suffer. I will share a truth with you – I have a 22 yr friend who has no insurance and recently was tired and had some labs drawn, has severe anemia, she tried getting insurance and you can imagine her plight while she is still looking for a job.

15. Ray–
    You write: “Medicare and social security passed because there was no cable media, no internet, no blogs, for some reason bad news, lies, ‘death panels’ travel’ faster faster than the truth and common people suffer.”
    This is very true.
    Lies, memes about “death panels” spread faster than the truth because they are usually very simple–one-liners, bumper-stickers, conservative “framing” of an issue.
    The truth about something as important as health care is always quite complicated–and complicated ideas just don’t spread as quickly.
    I’m sure you know this–but tell your friend to buy over-the-counter iron pills. (My daughter has been anemic in the past. Unless she has a very serious problem, they should do her a world of good.)

16. I’m reading your responses to other posts and I can’t believe them. It is indeed important to the country that we reform our health care model — which is exactly why I’m opposed to what is on the table: it isn’t reform.
    Your assertion that the too many people don’t understand the legislation may may be true but I’d also say that too many liberals don’t understand the problem and have crafted a “solution” doesn’t have much credibility.
    The problem we have in this country is not that too many people are uninsured. Our problem is that we have an unsustainable health care financing model that is bankrupting individuals, companies, and government at all levels to the extent that buying more of it will do nothing but accelerate our own decline. There is nothing in the bills you want passed that addresses that NOTHING.
    The liberal/progressive/[put your own label here] approach that calls for pouring more public money to buy more of that dysfunctional model is not reform and whatever you may think of their intelligence, most who do want reform people know it.
    Health Care Reform is not a poverty program; it is an issue of vital interest to the continued physical and financial stability of our country. Although you claim to believe that, all of your arguments end in the same place: “We have to trust that by buying more of what is the most inefficient model in the industrialized world will somehow get us out of this”.
    It just doesn’t wash.

17. Athena–
    I wonder if you have actually read teh Senate bill.
    As Timothy Jost wrote not long ago: “Anyone who says that the legislation would not control health care costs just hasn’t read the bill.”
    See also Paul Krugman’s most recent column on the need to pass the Senate bill.
    Jost is a brilliant healht care expert; Krugman is a Noble-prize-winning economist.
    Everyone has a right to his or her own opinion, of course, but doesn’t this give you pause?
    Doesn’t it seem likely that they have read the bill and understand it better than you do?
    What you don’t seem to understand is that waht drives the spiraling cost of healthcare in this country is not the financing model, and not fact that we buy it through private insurers.
    Our health care spending is driven by the underlying cost of care.
    The amount that private insuerrs pay out in reimburesements to docs, hospitals and patients every year has risen by 8% a year for the past 10 years.
    Why is that? Two reasons.
    First, we over-used medical technologies that often don’t benefit the patient. Too many unncessary and often unproven tests and procedures, unncessary surgeries . . We’re over-medicated.
    In addition, we overpay for virtually everything: we pay hospitals for being inefficient (they make more when patients develop preventable infections or suffer from preventable complciatoins); we over pay many specialists, often for procedures that provide little benefit to the patient. We way over-pay for drugs and devices.
    That is why our care is so much more expensive than in other countires.
    European countries use a variety of financing devices — None have a pure single-payer system.
    All of them spend far, far less because a) they use far less medical technology (fewer surgeries, many fewer tests, take fewer drugs) and because they pay less for everything (except primary care docs and nurses.)
    IF I were the only person saying this, that would be one thing But I am simply summing up what virtually everyone who has spent time studying our health care system says.
    This is not what you do for a living. This is what the 45 people who signed that letter–plus countless phsyicians, nurses, public health experts and health care economists do for a living.
    They disagree on many poitns, but they all agree that its the underlying cost of care that is teh problem– overtreatment and paying too much for every pill and procedure.

18. Athena and Maggie–
    Athena-
    I disagree with your limited view of “the problem” but largely agree w/your analysis that the current bills do too little on the cost control front to qualify as “reform”.
    The two major components of the hc crisis that you reference: the high number of uninsured and the highway robbery high cost of the US healthcare system, are not mutually exclusive. Both are alarming facets of the crisis, as is the 3rd major facet which is poor quality.
    Maggie-
    I disagree w/you on conclusions to be drawn from the MA exit polls. Many voters who don’t have a college degree are intelligent and pay attention, and many of them do not support the MAss. Plan for national reform b/c it does nothing to control runaway costs.
    Many Obama voters sat out the MAss Senate election, I think in large part b/c they are disilliusioned about the Dems and Obama’s seeming unwillingness to go to bat for us and to fight for ordinary Americans need for real health reform.
    Yes, this is very very frustrating but I think people across the political spectrum, and education level, will respond to politicians who put people before unbridled corporate profiteering in an effort to enact real healthcare reform.

19. In my prior comment I meant to include mention of and point readers to a poll with fascinating and important results r/t how we move might forward on health reform. The sample was 1000 Obama voters in MA. It was sponsored by DFA, Bold Progressives and MoveOn as f/up to the MA Senate election.
    Here’s the link
    http://pol.moveon.org/brownpoll/?id=18657-1372356-k4wLGPx&t=7

20. For the past several months I have been hearing polls cited that suggest more people oppose “the bill” than favor it. But little emphasis is usually placed on the fact that in addition to those who don’t want health care reform, many of those listed as opposed are ones who feel the bill in question doesn’t go far enough. This should give some comfort to Democratic Congressmen whose votes are influenced by the predicted effect on their re-election. A vote for the Senate bill, with a promise to try to reconcile its deficiencies, should help them with the people who elected them in 2008.
    I agree that our leaders need to lead. That should start at the top with the only guy that can sell us on health care reform, a serious effort at a green economy, real financial sector reform, and (later) tax reform. And after he does this, he doesn’t need to get re-elected….well, except to completely change our foreign policy.

21. DUMBEST REFORM POST OF THE WEEK (VII)

    Since the voters of Massachusetts gave Scott Brown the 41st vote against Obamacare, we have been subjected to a virtual tsunami of clueless articles and blog posts about the future of reform.
    So, once again, it was hard …

22. Maggie, Respectfully, I find your analysis to be rather slanted. Even hard core Democrats have admitted the obvious – that the Massachusetts drubbing is a repudiation on pending health care legislation. The President, as much, admitted the same. The Democrats have controlled this Senate seat for nearly 60 years. Massachusetts is a very blue state. The dominant issue in the campaign was health care reform. The electorate said ‘no’! The Democrats are now appropriately spooked because this seat was their lowest hanging fruit. I suspect that if Coakley had prevailed, despite her horrendous campaign, that you are other would be holding this up as an endorsement of health care ‘reform’. Why then, is her loss not a rejection of it? http://www.MDWhistleblower.blogspot.com

23. As soon as I hit ‘post’, saw 2 typos in my comment. Sentence at the end should read: I suspect that if Coakley had prevailed, despite her horrendous campaign, that you and others would be holding this up as an endorsement of health care ‘reform’.

24. “As Timothy Jost wrote not long ago: “Anyone who says that the legislation would not control health care costs just hasn’t read the bill”
    Well he (and you) are wrong. I’ve read the bill and justifications for the different provisions many times over. And denigrating the intelligence or understanding of people who disagree with you is not a very productive way progress an issue.
    Jost himself admits: “This is not to say that the legislation will actually control costs or improve quality…” In fact, the bills are replete with strategies, not to control costs in any sustained manner, but to tweak a failed model into yielding marginal cost reductions on some unseen horizon. Congress intentionally avoided issues that could result large tangible savings (e.g. allowing Medicare to negotiate for drug prices) in favor of vague programs that might have an indirect impact (e.g. the Cadillac tax) at some unknown time. They propose more demonstration projects as opposed to implementing programs that are known to be effective.
    “Doesn’t it seem likely that they have read the bill and understand it better than you do? ”
    Umm, not really. We are in the midst of a unfathomable economic crisis that was aided and abetted by all sorts of eminent economists who supposedly had a better understanding than than everyone else — including prominent critics who were ignored. My respect for many of the people who signed that letter doesn’t mean that I have to agree that this particular something is better than nothing; that having squandered the past year we can’t hope to do anything else now. Not to mention the fact that there are some key omissions in the list of signatories; people whose opinions I value quite highly.
    “Forget the personal politics. Forget who disappointed you. ”
    You are imputing motivations that have nothing to do with my comments. I have no personal stake in this other than wanting to see my country get on a path to providing what every other industrialized country does: medical security for its citizens. I may indeed be disappointed in Democrats, for whom 15 years was not sufficent time to craft a viable reform plan, but that doesn’t mean I can just sit by and let things go completely off the rails.
    “This is about people who need health care—and the fact that we must make that care affordable. ”
    No It Is Not: That would be a medical poverty program. THIS is about the medical and financial security of every man, woman, and child in the country. THIS is about moving the nation out of an unsustainable model and into one that will provide the same basic level of security for *all* Americans over the long term. THIS Maggie, is about R E F O R M.
    “What you don’t seem to understand is that what drives the spiraling cost of healthcare in this country is not the financing model, and not fact that we buy it through private insurers.”
    Excuse me but it is your understanding that is at fault. What you don’t seem to understand is that uncontrolled costs are a function of the financing model. Every one of the economists in your letter will tell you that having employer-provided insurance the cenerpiece of our policy is a major obstacle to actual reform.
    Your implication that I have a problem with private insurance is also incorrect. Private insurers are an integral part of many successful universal care *systems*. Universal though, means that everyone is in the same boat and therefore has the same level of security. That’s not what these bills are about.

25. ” Among Massachusetts’ voters who said health care was their top issue, 53 percent voted for Democrat Martha Coakley”
    In other words, 47% of those who said health care was their top issue voted for Scott Brown. 47% is not an insignificant minority of anything. Especially when those people have a better understanding of how the exchanges would work than the rest of the country.
    It’s time for a reality check among Democrats. The idea that the results in Massachusetts are not significant, that they should just ignore what happened and blame the outcome on everything but their own bad plan is a recipe for more disasters down the road.

26. After a week of hand-wringing by Congressional reform proponents, it’s probably worth reposting the link to some good news for them, sufficient to encourage a resurgent effort to pass the major reform proposals that have stalled for the moment –
    http://www.kff.org/kaiserpolls/upload/8042-F.pdf
    What this recent poll demonstrates is that the public supports the principle of healthcare reform, and is about equally divided on the current proposals. However, many respondents are unfamiliar with the proposals, and a substantial element of opposition was based on the misconception that the reforms would increase the deficit – in fact, it would reduce it. If that erroneous impression were corrected, reform might in fact enjoy a plurality of support.
    It would also be worth pointing out that the proposed reforms would begin to curtail rising healthcare costs outside of the federal arena as well – through primary care incentives, emphasis on appropriately chosen preventive medicine practices, comparative effectiveness research, controls on excess expenditures by hospitals and other providers, and exploration of alternatives to fee for service as a payment mechanism. These measures would serve only as a beginning and would need to be expanded, but they are an important beginning.
    In Massachusetts, Brown exploited the fact that the state alredy has a program similar to the proposed reforms, and claimed that Massachusetts residents would therefore be forced to contribute twice. That program, MassCare, is very popular in the state. A sizable majority of the voters in the Senate election favored it in polling, and that included a majority of Brown voters. Brown himself has praised it. In essence, far from repudiating healthcare reform in general, the Massachusetts voters were wary of endorsing a national program to be added to one they already had.
    I am hopeful, although far from certain, that reform proponents will take heart from these encouraging signs, and will proceed with a reform agenda that they have known with all its faults to be a major step forward, and which now appears to have at least the potential for tentative support from the public as well

27. Ann, Richard K
    Ann–
    Please read my most recent post on the two polls of Mass. voters.
    See also what I say about the Kaiser study which shows that the majority of Americans have no idea what the health reform legislation is all about.
    On the Move/on et.al. poll–Yes, as I note in my most recent post, many Obama supporters just stayed home.
    But Move/on tends to focus on a particuar group: progressives who are very interested in issues– mainly white progressives.
    These are not the people who put Obama over the top in 2008. If I remember correctly he got only 43% of the total white vote in this country (I though it was 47% but recently someone corrected me.)
    Certainly progressives helped, but a huge turn-out by African-Americans, Latinos, Asians and other legal immigrants made him the winner.. This is something that Gore and Kerry didn’t have. It made the difference.
    The demographics of the country are changing, and these are the voters that progressives need to focus on. The Democrats should have made sure that they brought out that vote.
    On whether the legislation reins in spending– First, we don’t want legislation specifying where health care spending will be cut.
    We do Not want politicians making these decisions.
    Secondly, please read Fred Moolten’s comment near the top of the page which begins by talking about the Kaiser report.
    He then goes on to describe the many ways that the legislation does lay out a roadmap for containing spending.
    It’s complicated, but he is right. This is the only way to contain spending.
    What I understand best about health care and health care reform is the economics of it. I started as a financial writer, and my book focuses on why health care is so expensive and what it would take to change it.
    This has nothing to do with whether it is employer-based or whether private insurers are involved. Both cost us something more but if we got rid of them it would be a one-time saving– AND WE WOULD STILL HAVE UNAFFORDCABLE HEALHT CARE INFLATION, year after year, because year after year, providers would do more, people would have more tests, more surgeries, and we would continue to overpay for almost everything in the health care market (except primary care and nurses.)
    This is what is killing us– the 8% inflation, year after year.
    Please trust me that this is the part of the legislation I understand best.
    Those who oppose it have said that it doesn’t control costs so many times that many peple believe them. This is why, as Fred points out, they don’t understand that the reform legislation would help bring down the deficit.
    The Whtie House (Obama, ORszag, Zeke Emmanuel) understand that there are two major reasons why we need health care reform:
    a) to provide access for everyone
    b) to save the economy from health care inflation that will lead to a larger deficit, the fall of the dollar, and ultimately, a sharp reduction in our standard of living.
    Economists like Paul KRugman and Uwe Reinhardt understand this. This is why they say vote for the Senate bill. They understand that it opens the door to getting at the underlying cause of health care inflatio: overtreatment and paying too much for everything.
    Finally, on what the public does and doesn’t understand about this bill. See my newest post and what I write about the Kaiser January tracking poll.
    Anne, you and I are immersed in these issues, so it seems hard to imagine that many people just don’t have the time or interest to care.
    But the truth is that they don’t.
    Most American voters do not pay much attention to issues. And less edcuated voters pay even less attention to issues.
    But this is not about having a college education. .
    Most of my friends have a college education and are not involved in health care. They have virtually no idea what is actually in the legislation. Their eyes glaze over if I talk about it at length.
    Bascially, they favor reform because they think uninsured and poor people need insurance. Most of them have employer-based insurance so they know that reform won’t affect them unless they lose their jobs.
    They are worried that their taxes will go up to pay for reform. They are smart enough to realize that any estimates of what reform will cost are wild guesses.
    They are not very interested in the subsidies, or the levels of the subsidies because they know they won’t qualify.
    They have no idea what the exchanges are or how they would work. They have no idea what a cadillac tax is or why some people seem to think a public option is such a big deal.
    They have no idea how insurers would be regulated.
    They don’t know that insurers can charge women more, so don’t know that the legislation would change this.
    They don’t like the idea of reining in spending,because they fear that this means they are their relatives won’t get all of the care that they want.
    They don’t understand that more care is not better care. They may reluctantly agree that there is waste in the system– particularly at the end of a person’s life. That’s about it.
    Sometimes they read my posts because they’re my friends and enjoy hearing what I say. But they don’t retain the details, because this isn’t their fight.
    At the Foundation where I work, everyone is keenly intersted in the political and social issues they work on, but no one can keep up with everything. Aside from Naomi, I can think of only 3 other people whose eyes wouldnt’ glaze over if I went on about health care.
    Most of the people I knwo are interested in politics, but they are more interested in talking about Haiti. It’s immediate. People died. There are orphans there. Why was it so poor in the first place? What was our involvement?
    By comparison, to most people health care and health care reform is a pretty dry subject.
    So I’m not putting people down when I say they have only a hazy idea of what’s in the bill . . . it’s just a fact.
    Richard K.–
    Thanks for your comment.
    Yes, some of the people who oppose the Senate bill believe it doesn’t go far enough.
    I agree with them–I would love a public option.
    And perhaps we can improve on the Senate bill at this time, but I’m not optimistic.
    There are just too many moderate Democrats in the Senate. The votes aren’t there for big changes.
    Maybe little changes can be made, but most importantly, if we can just get House liberals to vote for the Senate bill we will have something we can work with.
    Then we’ll have 3 or 4 years to improve it, amend it, etc. The alternative is that we have nothing; Democrats lose a huge number of seats in the fall, and Obama is a dead man walking.
    IF he is unable to pass healthcare reform he will be see as unable to govern, another Jimmy Carter. The moderates and Republicans will make sure that he is not able to pass a single major piece of legislaiton for the next three years.
    He must move on to jobs–Now. So he must get the Senate bill, or the senate bill plus a separate piece of legislation amending parts of it through Congress as soon as possible.
    I woudl add only that if anyone is going to do anything about Wall Street and our current financial disaster, they will need more than one term.
    Paul Volcker couldnt’ fix things in one term.
    Also, Obama needs to begin tax reform— at the top.
    Rates at the top are historically very low.
    One of the biggest problems in our ecnomoy is too much wealth concentrated at teh very top.
    That combined with 16% real unemployment creates a very unstable economy, and a very unstable society.
    .

28. First, I’d urge everyone to read Fred Moolten’s most recent post–near the top of the page– It begins with hand-wringing. A very good description of how the legislation will begin to curtail costs.
    Also, you might want to read my newest post on what Mass. voters said about why they voted for Brown before reading my responses below.
    Fred, Michael K., Athena-
    Fred– Yes, the Kaiser study is great. You’ll see I just wrote about it.
    Just one point of disagreement: it shows that Independents are evenly divided on reform, but Democrats are strong in favor of the legislation while Republicans are overwhelmingly opposed.
    Luckily, only about 20% of Americans now identify themselves as Republicans.
    Thanks for the excellent description of how the legislation does address spending– this is why it will bring down the deficit.
    Michael K.–
    First, if Coakley had won I would not hold it up as an endorsement of health care reform.
    I have followed U.S. politics for too many years to believe that most elections turn on issues.
    They turn on personalities.
    (Keep in mind, I’m Irish, grew up in a “The Last Hurrah” world.)
    The only exception: in a recession with high unemployment, people will vote their pocket-books—and vote the bums out.
    See my newest post on the exit polling and what it shows.
    Most imoprtantly, about 85% of the folks who voted for Brown said they knew he was against the reform legislation. About half said this made them like him more; about half said this made them like him less (but they voted for him anyway.)
    This was not a referendum on reform.
    I realize that most of hte pundits said that it was (with notable exceptions, including Ezra Klein, who is much smarter than most pundits.)
    I realize that people in the White House watch TV and the TV pundits, in particular, love the easy explanation: This was a Vote Against Health Reform.
    The fact that people in Mass voted for Brown for a zillion reasons does not make for a catchy headline
    Unfortunately, most, political strategists give presidents and presidential candidates very poor advice. They over-interpret when trying to read the public’s mind. Ask Al Gore about this.
    .
    How could a REpublican win in such a blue state?
    The polls show that unmarried women, Blacks, Latinos and younger voters stayed home.
    This is Obama’s constituency. Some of the younger voters might have gone for Brown– the Democrat seemed so out of it. But Blakcs and Latinos would not have repsponded to his frat-boy charm. And too many unmarried women have met guys like him. . . .(He’s a type; Either you like that type or you don’t.)
    The Democrats were too smug, had a horrendous candidate, and didn’t get the vote out.
    Athena–
    Yes, now I remember . . . I knew you had just one issue that you care about and now I recall: your issue is employer-based insurance.
    You don’t think it’s fair that employees don’t have to pay taxes on their insurance, and that someone who buys their own insurance has to pay for it with after-tax dollars (unless they are self-employed, in which case they get a big tax break.)
    You’re right: that isn’t fair.
    This just isn’t the biggest problem in our health care system.–and it’s not what’s driving health care spending.
    We have two much, much bigger problems:
    1) all of the people who have no insurance, either because they can’t afford it, or because they can’t get it due to pre-existing conditions.
    They are in much worse shape than somone buying insurance with after-tax dollars–as unfair as that may be.
    2) health care inflation which is caused by over-use of medical technologies that provide little or no benefit the the patient, and the fact that each year we pay more for every pill, device, piece of medical equipment, while total spending on hospital bills and most specialists also rises.
    Evern if we got rid of employer-based insurance, that would provide one-time savings that would be wiped out by a little over one year of health care inflation caused by over-treatment and rising prices.
    I realize you don’t agree. I can only urge you to read healthcare ecnoomist Uwe Reinhardt, the Dartmouth reserach, Atul Gawande, Don Berwick’s Escape Fire . . .

29. Karen—
    Yes, 47% of those who said health care was their top issue voted for Brown.
    But see my most recent post on what the voters said:
    The vast majority of Brown voters knew that he was oppopsed to the SEnate bill. Half of them said that made them like him more; half said that made them like him less (but they voted for him anyway.)

30. “Yes, now I remember . . . I knew you had just one issue that you care about and now I recall: your issue is employer-based insurance”
    That is an absolute mischaracterization of my position. I don’t have “just one issue” that I care about. I care about anything that increases social inequity and medical or financial insecurity on the part of working people.
    My issue with the tax treatment is that it is one of the clearest examples of the degree to which the left has abandoned any pretext of pursing universality and focused exclusively on raising money to fund a medical poverty program. You think it’s an inconsequential distinction whereas I think it indicates a fundamental problem in the objectives of the bills in question.
    “We have two much, much bigger problems:”
    First of all, I never said that the tax treatment was a “big” problem (beyond the fact that I think it would be grounds to invalidate the selective mandate); I simply disagreed with your equating a medical poverty program with reform and said that by denigrating the legitimate concerns of people who are paying their own way, reform advocates are alienating people who ought to be supporters.
    In any case, you just don’t get it Maggie: both of the problems you cite are a direct result of the dysfunctional financing model that you and Congress want to retain.
    “Evern if we got rid of employer-based insurance, that would provide one-time savings that would be wiped out by a little over one year of health care inflation caused by over-treatment and rising prices.”
    You’ve conflated two different things here and I suspect you are answering someone else’s argument about something else.
    There isn’t a country on earth that has successfully controlled costs with a patchwork of different payment arrangements and you cannot tweak this one enough to get us where we need to be fast enough. Employer-provided coverage, which creates myriad classes of consumers and separates most people from the actual cost of care, lies at the very heart of our inflationary cost problem. No successful universal care program is organized that way; it is a “uniquely American” mess.
    Changing from employer-provided coverage to a payroll tax funded system ( a la Germany) or any other *universal* model with unified cost negotiation would most definitely result in more than one-time savings. None of your favorite economists will tell you otherwise.
    As other countries have demonstrated, it serves to control the cost of actual care.
    “I realize you don’t agree. I can only urge you to read healthcare ecnoomist Uwe Reinhardt, the Dartmouth reserach, Atul Gawande, Don Berwick’s Escape Fire . . .”
    You seem to assume that anyone who doesn’t agree with you is just not intelligent or informed enough or that they are insensitive to the poverty around us. There are in fact, intelligent, informed people may have been reading and thinking about this for years and come to conclusions that differ from yours. To start with, you might want to revisit the authors you cite and read everything they say — not just the parts that support your pet issues.

31. Athena–
    This is not about people agreeing with me.
    As I make very clear in my book and try to make clear on this blog, I am synthesizing the views of some of the best thinkers in the world of health care and health care reform that I have found.
    This is why I quote others so often.
    My strength is that I can read huge amounts of research and essays that go into great depth; I can analyze and sythesize them, and write about the ideas in a way that many
    people find readable.
    Years of training as an academic taught me do that. I am now using that training to do something that I hope will be useful.
    Because I also trained as a journalist (on the job training), I know how to interview people and spot scams.
    I’m a translator. This blog is not about my views–it’s about what I have learned from others. I’m not a pundit. I’m a perpetual student and teacher.
    Finally, with regard to your last statement: I know the authors I cite. I have talked to them.
    They all agree (not with me but with each other): it wouldn’t make any sense to try to wipe out the system we have now and start over.
    We have to build on what we have and over time, we may transition to a better system. This is how real change happens.
    History tells us this.
    For example, in France, Gawande explains, “Long before the World War (WW II), “large manufacturers and unions had organized collective insurance funds for their employees, financed through a self-imposed payroll tax, rather than a set premium.
    “This was virtually the only insurance system in place, and it became the scaffolding for French health care. . . .”
    In other words, it was an employer-based system. “After the war, the de Gaulle government did not try to create an entirely new healthcare system.” Gawande reports.
    Instead, it “built on what it had. . health care was based on funds for their employees, financed through a self-imposed payroll tax, rather than a set premium. This was virtually the only insurance system in place, and it became the scaffolding for French health care. . . .” After the war, the de Gaulle government did not try to create an entirely new healthcare system.
    “The self-employed were added to the system in the nineteen-sixties. And the remainder of uninsured residents were finally included in 2000.”
    It took them a long time to build the system they have now.
    On the notion that we should scrap what we have and build an entirely new system, Gawande is eloquent:
    He is quick to acknowledge that the system we have is “an appallingly patched-together ship, with rotting timbers, water leaking in, mercenaries on board, and fifteen per cent of the passengers thrown over the rails just to keep it afloat.”
    And yet, and yet: “Hundreds of millions of people depend on it,” says Gawande. “The system provides more than thirty-five million hospital stays a year, sixty-four million surgical procedures, nine hundred million office visits, three and a half billion prescriptions. It represents a sixth of our economy. There is no dry-docking health care for a few months, or even for an afternoon, while we rebuild it.”
    Athean, you mention Germany . . . Germany’s original employer-based health care system goes back to the guilds of the Middle Ages.
    ” In Germany, the idea that employment and health care costs should be linked goes back centuries.
    “It originated in medieval craft guilds. Groups of blacksmiths, goldsmiths, carpenters and bakers banded together to make rules on who could practice their crafts.”
    “Such early “sickness funds” gave rise to the nonprofit health insurers that today cover 88 percent of all Germans from childhood through their working lives and into retirement.”
    (The other 12 percent of Germans still have private insurance.)
    “To understand its longevity, one must appreciate Germans’ penchant for perpetual health care reform. This constant tinkering represents the country’s effort to keep its health system fair and affordable. To an impressive extent, it’s worked.
    “In the past 20 years, Germany has enacted no fewer than six health care reform laws — one about every three years.
    “These reforms have required Germans to pay modest out-of-pocket copayments for doctor visits, hospital care and drugs.
    **”They’ve put doctors on budgets and told them where they may set up practice. . .
    This all comes from a 2008 piece on NPR which notes that:
    “The country’s most sweeping health reform was enacted last year. Among other things it:
    –Requires every German to have health insurance and requires insurers to provide it
    —Mandates that children’s care be funded by taxes rather than by employee premiums. (NOte : until 2007, employee premiums to employer-based insurance coveredd kids)
    –Requires new drugs to be cost-effective and bans direct-to-consumer advertising of
    prescription drugs
    —Sets up a mechanism to evaluate new medical technologies and decide whether they should be covered
    –Equalizes payments among sickness funds so younger, healthier people don’t flock to lower-cost insurers
    I’m not sure that these are the reforms that you are looking for Athena, but this is what is actually happening in Germany. Ghis is how they are controlling costs.
    (It all sounds very rational to me. )
    Finally, I would say that you seem to draw a sharp distinction between “the poor” and “those who are paying their own way.”
    The poor don’t “pay their own way” because, by definition, they can’t.

32. You may know the authors but you cherry pick the bits of their work that you agree with and ignore the rest.
    I read the Gawande article about how “Getting There From Here” when it was first published last year. It was especially interesting to me since I worked in all three countries and experienced the different health care systems first hand.
    “We have to build on what we have and over time, we may transition to a better system. This is how real change happens. ”
    Real change happens when leaders have specific goals and implement programs to achieve them. We don’t have the 50 years those countries spent refining their systems after the war. And of course many other (smaller) countries have benefitted from that history and implemented wholesale transformation in the past 15 years.
    There is no “plan” in these bills, just more of the same. And Gawande certainly does not advocate sticking with that. Read his article again (or call him up if your such good buddies), he advocates using what is there to take some steps toward universality, not reinforcing what we know is a bad idea.
    “Finally, I would say that you seem to draw a sharp distinction between “the poor” and “those who are paying their own way.”
    1. Read what I said again. I didn’t distinguish between the “poor” and those who are paying their own way, I distinguish between those who are paying their own way and the majority who aren’t — poor or not.
    2. It doesn’t really matter why some people can’t pay their own way, it is still hypocritical for someone who advocates a more equalitarian socieity to promote a policy that penalizes those wo do.

33. Athena–
    I think that we should agree to disagree.
    Clearly you have thought about this issue and spent time on it.I doubt that anything I might say would sway you.
    At the same time, I won’t agree with your belief tha “It doesn’t really matter why some people [the poor,ec.] can’t pay their own way.”

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