I didn’t post about the vote earlier today, because I cannot begin to predict what will happen next. There are too many variables. At this point in the process, a few politicians can begin to make demands that could actually block any reform legislation this year.
I still feel strongly that Congress should try to pass a bill, even if it is legislation that I find terribly disappointing.. But –and this is crucial– it must be a bill that makes it clear that we, as a nation, believe that everyone deserves good, affordable healthcare, and that we are all willing to share in doing what it takes to provide that security for everyone.
That’s the bottom line. The bill must mark a turning point: we have made a decision that healthcare is something than any civilized society should provide to all of its citizens. If we do that, I think it will be like civil rights legislation. There will be no turning back.
This is why conservatives are so upset about the current legislation: they fear that there will be no turning back.
Going forward, I would say just one thing with some certainty: Beware of those who say that progressives must “go back to the drawing board” and work with conservatives to forge a bipartisan bill.
Conservatives don’t want reform, at least not as progressives define it: “equal opportunity” for all who need care. “Universal coverage” is not the goal that conservatives seek. They would continue to discriminate against the sick and low-income families. They believe that a competitive market could offer the soltuion to our health care crisis. ((I’ll be writing about this tomorrow when I take a look at Safeway’s Solution.)
Conservatives blame the sick for being sick, and they fault the poor for being poor. Health care reform must be compassionate, and it must be equitable.
democrats, president,supporters,press, no one presented the case properly to common people. It was too complicated to make it simple enough for lay public. It was too much under pressure from special interests to be real reform. At least lessons learnt can tell that you can not demand special deals for greater good and president can now lead a good legislation beyond normal politics??
I would agree with the prior post and I believe Obama has already acknowledged that they did a poor job of selling this legislation. The side deals that they did to garner the 60 votes in the Sentate soured people to the whole process and raised suspicions. The majority of people in this country are healthy and insured; consequently they have no idea how tenuous things are if they get sick; only then do they discover how poor their insurance really is or that once they lose their jobs, the insurance goes out the door with it. Finally, it was not well laid out what this might actually cost people in terms of increased taxes and what they would get in return.
I am very saddened and concerned for the future of our country if we cannot reach a national consensus as to the importance of basic health care for all its citizens. Once again, it seems the special interests will win the fight.
I don’t think it was a failure to “sell” legislation. It was a failure of the President to take the lead on the issue and not give in to the special interests, including certain democrat senators.
Also, the white house was too slow to respond to wild attacks and falsehoods that got a life of their own this summer.
The president also got taken by the republicans in the “gang of six” actually believing they were negotiating in good faith, when in fact, they were setting him and the democrats up to look like spineless fools.
I read somewhere that Canadian Medicare was passed with a bill only sixteen pages long. A floor rather than a ceiling.
Americans have come to mistrust great, fat documents (think banking agreements, mortgage documents, insurance policies and, yes, medical refords) because they contain too much material not understandable by lay people. In light of all the fallout we/they have experienced lately from such documenets, that fear and mistrust is not without reason.
Those of us who have been following the debate know well how many convoluted “agreements” are enshrinbed in two thousand pages of Congressional mouseprint.
A simple bill allowing a Medicare buy-in for people after age 55 coupled with two or three simply-worded, iron-clad insurance reforms could sail through both houses with no problem but the medical-industrial complex has too tight a grip on our elected representatives to allow such a commonsense remedy.
John–
At the moment there might be much to be said for simplicitiy–except healthcare is never simple.
Howard Dean has suggested just passing Medicare for everyone ove 55.
The problem: that is a very, very expensive pool of people. If they are going to buy into Medicare, the cost of providing them with Medicare-equivalent benefits would be about $20,000 per couple.
(You can’t tap into the current Medicare fund to cover them– that money is already spoken for to cover people over 65–and at the moment, it’s not enough to do that. )
So you would also have to pass subsidies for everyone over 55 earning less than, say $150,000– which is the vast majority of people over 55.
Meanwhile, you would know that you were throwing money into a Medicare system where about 1/3 of the dollars are wasted on unncessary tests, treatmens, etc. etc. .. .
As for “iron-clad insurance reforms”– I assume you mean a law saying that insurers cannot deny for pre-existing condition, must insure everyone and must charge everyone in a given community the same premiums of rhte same policy, regardless of whether they are sick or well.
You cant do that unless you add an individual mandate. Otherwise, people will wait until they are sick to buy insurance and because only sick people will be in the pool, it will be hugely expensive for eveeryone.
As Paul Krugman explained recenetly, the pieces of the health reform legislation tend to depdend upon each other–often you can’t pass one without the other.
>>”…the cost of providing them with Medicare-equivalent benefits would be about $20,000 per couple.
>>”(You can’t tap into the current Medicare fund to cover them– that money is already spoken for to cover people over 65–and at the moment, it’s not enough to do that.)”
Does that mean twenty grand before or after they buy in? And “buying in” need not mean getting in at the same price. Those still earning presumably have more resources than those in retirement, and employers might very well assist.
As for mandating insurance for all, that goes without saying. I know the insurance industry has products for sale for anyone similar to the “postman’s plans” (or worse) from FEHBP. One former employer I worked for offers a “plan” that seems never to pay out a dime more in claims than it collects in premiums per person. That wrinkle could be wrapped in an insurance rule protecting those who buy good insurance and penalizing those who do not. Of course Medicaid kicks in at some point anyway.
There seem to be 2 key factors that drove the Mass. voters:
They already have universal coverage and they have insurance through their jobs.
Therefore, the hell with everyone else.
I’m not concerned about the politicians. An informed populace will weed them out. The problem is that we as a people are uninformed, spend out time being “entertained”, get our information from sound bites, and are utterly self-absorbed.
The Founder had deep devisive issues among themselves to overcome, and they did. We can’t get out of our own way.
“we, as a nation, believe that everyone deserves good, affordable healthcare, and that we are all willing to share in doing what it takes to provide that security for everyone. ”
The problem is that a significant number of Americans do not believe those things, never have, and never will. And they might win.
Tom:
You are correct that the people, in general, are uninformed and self-absorbed.
I believe people do not think it is relevant or practical to be involved.
The “bottom line” is they just don’t have the time (which could very well be true)!
We used to say, in effect, that being informed and unabsorbed and 50 cents, will get you a cup of coffee.
Well, you can see how many years ago we used to say that, and it still applies today.
Don Levit
Hootsbuddy–
I mean that it would cost a couple $20,000–out of their own pocket–in premiums to buy into Medicare. They would also face co-pays and deductibles, just as people in Medicare for those who are over 65 do.
Usually, when people talk about opening Medicare up to people over 55, they are talking about making it available to those who do not have employer-based insurance– the self-employed, the unemployed, and those who have retired early.
So no one would be helping out with the premiums.
If you let people who do have employer-based insurance opt in, employers would contribute about what they do now– anywhere from $6,000 to $13,000 for a family plan, leaving the 50-something couple to pay far more than they do for employer-based insurance ( for which they somewhere between zero and $4,000 toward premiums.)
Relatively few 50-somethings would give up their employer-based insurance for this deal–unless they were very sick and their employer-based insurance just wasn’t good enough.
Thus the pool of people signing up for this program becomes that much more expensive.
Finally, whenever talking about letting people over 55 sign up for a plan that is very much like Medicare (though financed separately) it is always assumed that everyone gets the same benefits for the same price. That’s what people like about Medicare.
The difference is this: since people contribute to Medicare over the course of a career, the amount they put in is a percentage of their salaires — when they’re earning more, they put in more.
But under this plan, they would be paying today for coverage that they would use tomorrow: the sliding scale wouldn’t work so well. (There wouldn’t be time for their income to go up over time.)
Probably everyone would have to pay the same flat rate, and then we would give tax credits or subsidies to those who couldn’t afford the $20,000.
This becomes very, very expensive for tax-payers.
During the Clinton administration there was talk of opening Medicare to those over 55 and to
people 18-35 (if I recall correctly–I may have hte ages wrong, but it was younger people.). With more young people, the pool woudl be less expensive.
But these days, given the cost of health care, I doubt that young people would go for it.
Forgetting partisan politics, what if going back to the drawing board meant crafting a bill that got wide public support and didn’t cater to the special interests on either side?
Wouldn’t wide public support cure all ills and effectively create bipartisanship?
What politician doesn’t kiss a baby for the camera?
ray,Keith, Gary,Tom, jsmiith, Don, Ed
Ray– The problem is that health care reform is very complicated– a great many pieces that all depend on each other (insurers can’t refuse to cover people with pre-existing conditions; thus we have to have a mandate; thus we have subisdies so that people can afford the mandate; that we have to have funding to pay for hte subsidies (a Cadillac tax– or a tax on people earning over $500,000); and if the subsidies are going to be affordable for taxpayers, we have to have programs that begin to change what we pay for, how we pay for it, and how health care is delivered (all of the Medicare reforms in the bills) . . . I could go on.
Health care reform will always be under pressure from corporate intersts—unless we have far-reaching and radical campaign finance reform.
And we can’t wait for that to happen. We have to get a handle on health care as soon as possible.
See what I wrote about how Medicare was passed. In this country, this is how legislation is passed.
The big problem in this case is that Congress–and the country are so polarized. As jsmith points out in his comment above, “a signficant number of Americans don’t believe that everyone shoudl have health care.”
The division between conservatives and liberals on this issue is all about values. Conservatives believe in “personal responsibility”–eveyrone should take care of themselves. Liberals believe that we shoudl take care of each other–and that some of us are not able to take care of ourselves because we’re poor, sick, old . . .
Keith– The truth is that most people in this country have employer-based insurance.
Health care reform would not change their lives. They wouldnt’ get anything in return—except teh secruity of knowing that if they lose their job, or their employer can no longer afford the insurance, they will still have access to healthcare.
They also will know that they know live in society which has said that we believe that we have a responsiblity that everyone has care.
But as jsmith notes in his comment– many Americans dont’ believe that.
It don’t think it would have helped for Obama to acknowledge that most people who now have employer-based insurance won’t get anything in return.
And, they may well have to pay something to help others.
How much? We have aboslutely no idea.
We don’t know how much health care the currently uninsured will need. We don’t know what that care will cost in 2013 or 2014.
We don’t know how doctors and hospitals will respond to the many financial carrots and sticks that Medicare hopes to use to bring prices down.
We don’t know if Congress will let Medicare bring prices down.
We don’t know how much drug-makers and device-makers will hike prices on their products . . .
So, we can’t tell taxpayers how much this will cost them.
All we can tell them is what Obama has already told them: if we don’t do anything, health care inflation will continue at its current pace, and your health care premiums will double over the next 9 years. But your wages won’t double.
So we must do something Now.
It is sad that we can’t reach a national consensus on this. But I think our leaders in Washington must go ahead, even if a significant portion of the public doesn’t understand and doesn’t care what happens to the country as a whole.
This is much like civil rights legislation–many people didn’t want it, but leaders went ahead (LBJ and Martin Luther King) and we got it.
Gary–
You write: “Also, the white house was too slow to respond to wild attacks and falsehoods that got a life of their own this summer.
The president also got taken by the republicans in the “gang of six” actually believing they were negotiating in good faith, when in fact, they were setting him and the democrats up to look like spineless fools.”
I agree about all of this.
And since the Mass. election, I have been disappointed that Obama has not stepped forward and said “we’re going to pass the Senate bill”–or “we’re going to take this to reconciliatoin.”
But when it comes to dealing with special intersets, including certain Democratic Senators–he had no choice.
Short of taking out a contract on Lieberman, there was nothing he could do except give him what he demanded him.
Lieberman wasn’t going to change his position for love or money–he wanted to show the Democratic party how powerful he is.
And once Lieberman stood up, the moderates had a leader and began demanding things.
I don’t blame Obama for Lieberman; if anyone is to be blamed, it is the people of Ct. who elected Liberman. He has been a santimonious opportunist for many, many years.
The president just doesn’t have as much power as people think he has. The majority of white voters did not vote for him. The moderates in the Red states know that.
The majority of their constituents did not vote for Obama. So they’re not behind him.
As for corporate special interests, as long as corporations can give large sums to Congress, they will have enormous influence over how legislators vote.
This is not something Obama or any president can change, unless he can persuade Congress to vote for serious campaign finance reform.
This Congress is Not going to do that.
Meanwhile, we have a Supreme Court which has just ruled that corporations have a right to use their money to try to run the country.
So in this regard, Obama had to deal with the hand he was dealt.
What he didn’t have to do , however, was waste a lot of time negotiating with conservatives who were never going to suppport reform. That was foolish.
Tom: You write: ” The problem is that we as a people are uninformed, spend out time being “entertained”, get our information from sound bites, and are utterly self-absorbed”
I am afraid that this is true of much of the population.
jsmith–You write: “The problem is that a significant number of Americans do not believe those things, never have, and never will. And they might win.”
Yes, this is the awful truth–and why we must continue fighting.
Don– It is discouraging to realize that this attitude goes back to a time when a cup of coffee cost 50 cents.
Ed– There is no bill that would get wide public support.
As others on this thread have said: a majority of American have employer-based insurance.
Many of them are satisfied with it, and not terribly interested in whether or not other Americans have accedss to care.
Meanwhile, they are wary that expanding access would cost them something . . .
A sizeable number of people want “reform” but only reform that benefits them and their families– not reform that helps other people.
So there is no one plan that most of the public would like.
We’re too fragmented.
And health care reform is too complicated for a great many people to understand what it would do and why it is important.