Senate Sends Health Care Bill to Floor

November 22, 2009 7:36 AM

The Senate votes to bring health care bill (text in an amendment) to floor, 60-39. Major concessions extracted by holdout senators. Other analysis here and here. Differences between this and the House bill.
posted by shivohum (74 comments total)

As a constituent of Landrieu's, I love how she takes a 'principled stand against government waste', until she managed to score an extra $100 million in federal funds for Medicaid.
posted by The Giant Squid at 7:46 AM on November 22, 2009 [5 favorites]

It's all in the game baby, all in the game.
posted by Brandon Blatcher at 7:48 AM on November 22, 2009 [3 favorites]

I'm not sure I'd call spending an extra hundred million on healthcare is government waste.
posted by Pope Guilty at 7:48 AM on November 22, 2009 [4 favorites]

Unless you're one of those people who thinks "government waste" and "government spending" are the same thing, in which case I am pointing at you and doing the Nelson Muntz laugh.
posted by Pope Guilty at 7:49 AM on November 22, 2009 [6 favorites]

"My vote today," she said in a soft Southern accent that masked the hard politics at play, "should in no way be construed by the supporters of this current framework as an indication of how I might vote as this debate comes to an end." Among the concessions she'll seek: more tax credits for small business and a removal of the version of the "public option" now in the bill.

Christ, what an asshole.
posted by ShawnStruck at 7:50 AM on November 22, 2009 [13 favorites]

Am I correct in assuming that the holdouts extracted money for their states but only to vote to go forth with debate (and thus no filibuster), buy that they might later vote against the bill and still have their states get what they were promised as a payoff to begin debate?
posted by Postroad at 7:52 AM on November 22, 2009

I'm not sure I'd call spending an extra hundred million on healthcare is government waste.

Yet Landrieu seemed to think it was, up until the point where she scored a bigger chunk of it (which is, I think, the point The Giant Squid was trying to make).
posted by inigo2 at 7:52 AM on November 22, 2009 [3 favorites]

Over and over again, I wonder why in the hell I (or anybody else) work so hard for Mary, when she clearly despises the liberals who put her into power.
posted by The Giant Squid at 7:55 AM on November 22, 2009

Wake me when they get 60 votes to invoke cloture.
posted by drpynchon at 8:09 AM on November 22, 2009

Sen. Ben Nelson (D-Neb.) got Reid to jettison a provision stripping health insurers of their antitrust exemption.

Heckuva job, brownies!
posted by Kirth Gerson at 8:10 AM on November 22, 2009 [2 favorites]

I'm surprised, and a little impressed, by how openly Landrieu and Lincoln are saying that they'll be coming back to bleed the stone a little more in a few weeks. Ballsy.

I write this as a Canadian who is thoroughly confused by the open hostility towards the public option plans.
posted by dnesan at 8:12 AM on November 22, 2009

All Democrats and Independents voted affirmative and all Republicans voted negative, except for Ohio Sen. George Voinovich (R) who thought the whole thing was a waste of time.

"Voinovich says he sees no reason to approve procedural matters that will start moving the Senate bill forward if the bill itself is flawed. Why waste time on preliminary debates — starting with a first vote by this weekend to cut off debate on a motion to proceed, followed by 30 hours of debate on the motion to proceed itself, all before an eventual vote on the actual bill — when there is other unfinished business to deal with, including spending bills that are months behind schedule?"
posted by netbros at 8:16 AM on November 22, 2009

I just finished watching Senator Coburn and Representative Blackburn on Meet The Press. As they represented the Republican side of this issue, the ignorance and doubletalk coming out of their mouths almost made me throw my coffee cup through the TV.

Coburn conceded that he hasn't read the Senate bill, yet he teed off on it at every chance.

Blackburn kept insisting that the new mammogram study was the "first step in rationing" (read "red Commie Socialist Nazi Armageddon") - as if private insurance companies would neeeever use that information to cut back on what they cover.

And they both said they don't want "a government takeover of the health care system". They are for ending pre-existing condition refusals and recisssions. So I guess they are for some "government takeover", but only if they agree with it.

Couple these idiots with their reactionary Republican brethren, throw in the still fence-sitting Nelson, Lieberman, Landrieu and Lincoln and I still give this whole thing a better chance of blowing up than passing. I hope I'm wrong.
posted by Benny Andajetz at 8:19 AM on November 22, 2009 [1 favorite]

I write this as a Canadian who is thoroughly confused by the open hostility towards the public option plans.

This hostility is manufactured. There are individuals (corporate and human) who stand to lose a great deal of money if heath care finance is reformed (note I do not say health care; there's very little about actual health care being discussed, near as I can tell).
posted by Pragmatica at 8:20 AM on November 22, 2009 [10 favorites]

except for Ohio Sen. George Voinovich (R) who thought the whole thing was a waste of time.

Wow — I had no idea Voinovich succeeded Dennis Kucinich as mayor of Cleveland until I read that article.

Cleveland voters, you are very strange.
posted by enn at 8:23 AM on November 22, 2009

Just a guess, but I'm thinking that Blanche Lincoln's not thinking about reelection because she figures she's doomed. She didn't win by much in 2004, her approval ratings are tanking, and her efforts toward a warmed-over sellout healthcare bill aren't pleasing anybody in the state. All that, and she's rolling in money from big pharma and insurance companies.
posted by box at 8:28 AM on November 22, 2009

enn: Cleveland voters, you are very strange.

Ohio in general I think.
posted by shakespeherian at 8:31 AM on November 22, 2009

The US desperately needs to remove most of the incumbents and re-populate those seats with honest people who have big ideas about how society means looking after one another. 'cause it seems all ya got right now are pirates and the criminally insane.
posted by five fresh fish at 8:33 AM on November 22, 2009 [10 favorites]

Among the concessions she'll seek: more tax credits for small business and a removal of the version of the "public option" now in the bill.

Coincidentally, to get my vote in 2012, one of the concessions I'm requiring is a removal of Congresspersons more interested in protecting big business than the human public.
posted by DU at 8:34 AM on November 22, 2009 [5 favorites]

Ben Nelson of Nebraska, nominal Democrat, used to be the CEO of the insurance company headquartered at this address.
posted by You Can't Tip a Buick at 8:35 AM on November 22, 2009 [4 favorites]

I'll see your Springer and raise you a Traficant.
posted by box at 8:43 AM on November 22, 2009

Was I hired to stand in the way of health care reform?
posted by netbros at 8:56 AM on November 22, 2009 [2 favorites]

What does a doctor think? (via)

- The House bill is completely inadequate in expanding coverage and controlling costs. It is essentially an insurance industry bailout. ... The Senate bill would have even less impact, leaving at least 24 million Americans uninsured.

- The Senate bill provides $447 billion in taxpayer subsidies to insurers.

- ... insurers are still allowed to deny claims, and two industry whistleblowers... have testified before Congress that the industry is now so sophisticated in its ability to deny claims, control care, and cherry-pick that these protections are essentially worthless.

- Similarly, caps on out-of-pocket expenses... don’t prevent medical bankruptcy because they don’t include expenses for uncovered services.

- Insurers are supposed to spend 85 percent of premiums on care, but experience from Minnesota shows that insurers are able to circumvent this rule easily by categorizing administrative expenses as “clinical” or “quality improvement.”

- In the Senate bill, only about 1 percent of Americans (3-4 million) will enroll in the public option, and states can choose not to offer it.

Are we allowed to root for failure yet? Or do we have wait until the Stupak-Coathanger amendment, full strength, is put in the combined bill? [If it cost $100 million just to buy a floor debate, you know it will cost something far worse to buy cloture.]
posted by Joe Beese at 9:05 AM on November 22, 2009 [3 favorites]

I don't see why anyone is getting so riled up about this.
The bill is a blatant, unconstitutional, mandated giveaway to private insurance companies.
How can it be constitutional for citizens to be forced to buy insurance from private companies.
Does that mean that without it that you give up your citizenship? Without citizenship, what other rights can be violated? Jail time? Deportation? Internment? Fines? What if you can't afford the fines? Who enforces it?

This vote may pass, but upon review, it will be struck down as violating the constitution.
This whole thing is political theater with no positive outcomes, just posturing.
This isn't about health care for anyone.
posted by Balisong at 9:11 AM on November 22, 2009 [3 favorites]

It's clear we're rapidly approaching and may indeed already have passed the worse-than-nothing point.
posted by enn at 9:15 AM on November 22, 2009 [6 favorites]

Joe, I don't think you'll have to root much. From my perspective, the opponents have been sufficiently successful in undermining the reform effort to where anything that ultimately passes would serve the citizenry best if Obama simply vetoes it once it gets to his desk. Better that than hang what is looking more-and-more like an insurance industry give-away albatross around citizens necks.

This nation is so incredibly fucked.
posted by Thorzdad at 9:19 AM on November 22, 2009 [2 favorites]

I thought your "text in an amendment" link was going to let me add an amendment to the health care bill with a text message. I was sorely disappointed.
posted by Salvor Hardin at 9:27 AM on November 22, 2009 [3 favorites]

Thorzdad: "Joe, I don't think you'll have to root much. From my perspective, the opponents have been sufficiently successful in undermining the reform effort to where anything that ultimately passes would serve the citizenry best if Obama simply vetoes it once it gets to his desk."

And you actually believe that Obama would consign the signature initiative of his administration to failure by vetoing it simply because it would serve the citizenry better?

For that matter, you actually believe that this undermining wasn't entirely in accordance with Obama's wishes as he diligently served his corporate paymasters in Big Pharm? You think he was sitting at his desk in the Oval Office wringing his hands and lamenting "Why oh why does Rahm insist on strong-arming the progressives rather than the Blue Dogs? Doesn't he understand how this will undermine reform?"
posted by Joe Beese at 9:27 AM on November 22, 2009 [7 favorites]

For that matter, you actually believe that this undermining wasn't entirely in accordance with Obama's wishes

Let's all say this together: If Obama was actually an agent of change or reform he wouldn't have been allowed to run for president. Obama is the true hero of the status quo but the conservatives haven't realized it yet.
posted by fuq at 9:39 AM on November 22, 2009 [7 favorites]

What does a doctor think?

I am shocked, SHOCKED, that a post on the website of a group pushing single payer healthcare finds problems with House and Senate bills or that someone who paints President Obama as a servant of "corporate paymasters" would be pushing such a link.
posted by Brandon Blatcher at 9:41 AM on November 22, 2009 [3 favorites]

I am not shocked that you found it easier to go ad hominem on me than defend the bill.
posted by Joe Beese at 9:43 AM on November 22, 2009 [2 favorites]

An alternate viewpoint:

"I'm sort of a known skeptic on this stuff," Gruber told me. "My summary is it's really hard to figure out how to bend the cost curve, but I can't think of a thing to try that they didn't try. They really make the best effort anyone has ever made. Everything is in here....I can't think of anything I'd do that they are not doing in the bill. You couldn't have done better than they are doing."

posted by argybarg at 9:48 AM on November 22, 2009 [1 favorite]

Sen. Ben Nelson (D-Neb.) got Reid to jettison a provision stripping health insurers of their antitrust exemption.

I will repeat this for the benefit of our less intellectually gifted representatives: WHEN YOU EXPLICITLY PERMIT CARTEL BEHAVIOR, YOU INCENTIVIZE OUTPUT RESTRICTIONS AND MONOPOLY PRICE MAINTENANCE TO MAXIMIZE CARTEL MEMBERS' PROFITS. THE END RESULT IS A REDUCTION IN AGGREGATE AND CONSUMER WELFARE. THE MONOPOLY PREMIUM IS SUBSEQUENTLY DISSIPATED IN FURTHER RENT-SEEKING.
posted by Inspector.Gadget at 9:48 AM on November 22, 2009 [16 favorites]

As dismayed as I am at the watering-down that's been forced on the bills since the beginning, I can still defend it this way:

It's a start.

That's it.

By any objective standard, our existing system is insane. It's too expensive. It's run for profit. It doesn't cover everyone. It exists outside of anti-trust laws. The results are terrible when compared with all other industrialized countries. In sum, it serves insurance companies' interests FIRST.

I say get whatever new legislation you can get, at first. Get the population more accustomed to having the government more involved in health care; more accepting of the fact that health care in the U.S. is a birthright. Then get to work on making it better and more responsive to the people. Once the tipping point is reached, our "representatives" will be facing a much more demanding electorate- one they can't ignore as easily as they do today.
posted by Benny Andajetz at 9:56 AM on November 22, 2009 [4 favorites]

How can it be constitutional for citizens to be forced to buy insurance from private companies pay taxes.

FTFY
posted by justkevin at 10:04 AM on November 22, 2009 [2 favorites]

I am not shocked that you found it easier to go ad hominem on me than defend the bill.

1. Busy day

2. It's hard to take you seriously when you use language that you use. You sound like a teabagger and there's no reasoning with that sort of hysteria, so why waste the breathe? Seriously, I'm not above listening to you and that line of reasoning but could find some other links and express in them in less "OMG WE'RE FUCKED AND DOMMED UNDER THE RUNNING LAP DOG OBABM?!" tones?
posted by Brandon Blatcher at 10:04 AM on November 22, 2009 [3 favorites]

The bill is a blatant, unconstitutional, mandated giveaway to private insurance companies.
How can it be constitutional for citizens to be forced to buy insurance from private companies.

Balisong, do you not live in a state that requires you to have auto insurance if you're going to drive a car?

Good that the debate will rage on. There is more to be worked out. For the final law, I'd suggest knocking the subsidies down a bit-- a family of 4 making 400% of the poverty level? Can we try 200%?
posted by njbradburn at 10:14 AM on November 22, 2009

How can it be constitutional for citizens to be forced to buy insurance from private companies pay taxes.

FTFY
posted by justkevin

So there is a poverty level threshold where you don't need to buy a policy?
Is there loopholes for the upper earners to not participate?
posted by Balisong at 10:15 AM on November 22, 2009

Balisong, do you not live in a state that requires you to have auto insurance if you're going to drive a car?

Yep. Driving a car is different from medical care. People do not have to drive cars, thus, they do not have to buy policies. This would be like mandating that everyone buy auto insurance whether they drive or not. How about home owners insurance if you do not own a home. Not constitutional. Your analogy is not equal.
posted by Balisong at 10:19 AM on November 22, 2009 [2 favorites]

I'm not arguing with you, I'm agreeing with you that the constitution doesn't give the federal government the right to tax income. Wasn't that your point?
posted by justkevin at 10:21 AM on November 22, 2009

Benny Andajetz: "I say get whatever new legislation you can get, at first. ... Then get to work on making it better and more responsive to the people. Once the tipping point is reached, our "representatives" will be facing a much more demanding electorate- one they can't ignore as easily as they do today."

As powerful as the insurance lobby was in crippling reform this time, it will be even more powerful next time - assuming there is one - after the government gives them half a trillion dollars of our money.

And what are we getting in return for that colossal sum? [emphases added]

The employer mandate of the Senate bill virtually ensures the demise of employer based insurance and not for good reasons. It will be pretty cheap for your employer to dump you. The fine for large employers is $750 per employee, probably cheaper than the premium to insure an employee. ...

The bill contains an anti-choice provision, but it's something less than the Stupak Amendment, but greater than the old Hyde Amendment. ...

... there are to be 2 different exchanges, one for the individual market and another for the small business market. Isn't the whole idea to create one big risk pool to spread around the risk? Expect ulterior motives here. ...

Senate Democrats proudly proclaim that 94% of Americans will be covered by insurance under this bill. They forget to mention that it's because they will be mandated to purchase insurance. The mandate can be found in Section 5000A. It kicks in a year before the pre-existing condition exclusion does.

Sorry, but the "worse than nothing" line is already fading into the distance in the rear-view mirror.
posted by Joe Beese at 10:28 AM on November 22, 2009 [5 favorites]

balisong: How can it be constitutional for citizens to be forced to buy insurance from private companies.
Does that mean that without it that you give up your citizenship? Without citizenship, what other rights can be violated? Jail time? Deportation? Internment? Fines? What if you can't afford the fines? Who enforces it?

My, my, the hysteria! Give up citizenship! Deportment! Internment!

It is legal according to the 16th amendment to the Constitution and adjudicated by the Supreme Court. If you don't have health insurance, the requirement is a small increase in your income tax, 2.5%, and will be enforced by the IRS just like it has for the last 100 years. For many people, the 2.5% tax is cheaper than health insurance.

You may now resume your regularly scheduled hysteria.
posted by JackFlash at 10:29 AM on November 22, 2009 [5 favorites]

Yep. Driving a car is different from medical care. People do not have to drive cars, thus, they do not have to buy policies. This would be like mandating that everyone buy auto insurance whether they drive or not. How about home owners insurance if you do not own a home. Not constitutional. Your analogy is not equal.

How about health insurance when you never get sick?
posted by battlebison at 10:29 AM on November 22, 2009

This would be like mandating that everyone buy auto insurance whether they drive or not.

I agree noncorporeal beings should be exempt from health insurance.

Sorry, but the "worse than nothing" line is already fading into the distance in the rear-view mirror.

I think everyone involved pretty openly ran on a campaign of doing something over nothing, so if you don't agree with that, blame the voters. The only representatives I can see who have really misrepresented their intentions are the "moderates," who claimed to support reform, but clearly don't.
posted by scottreynen at 10:33 AM on November 22, 2009

So there is a poverty level threshold where you don't need to buy a policy?

Yep:

House version:

Includes mandate.

Penalty: Tax equal to 2.5 percent of adjusted gross income over certain thresholds ($9,350 for individuals, $18,700 for couples).

Exemptions: American Indians, people with religious objections and people who can show financial hardship.

Senate version

Includes mandate.

Penalty: Starts at $95 a year per person in 2014 and rises to $350 in 2015 and $750 in 2016, with a maximum of $2,250 for a family. No penalty if the cost of cheapest available plan exceeds 8 percent of household income.

Exemptions: American Indians, people with religious objections and people who can show financial hardship.
posted by Benny Andajetz at 10:39 AM on November 22, 2009

Your analogy is not equal. I see where you're coming from, Balisong, but I think the real point is mandating insurance, not what is actually being insured. That is actually a public health issue, which is most certainly the domain of the Government--which is, of course, the elected representative of We the People, upholding the Constitution, etc... ;>
posted by njbradburn at 10:41 AM on November 22, 2009

The US desperately needs to remove most of the incumbents

Most of the incumbents are voting for health care. In fact, most of them would vote for it without any of the watering-down that's being threatened by a certain few.
posted by Flunkie at 10:42 AM on November 22, 2009 [1 favorite]

scottreynen: "The only representatives I can see who have really misrepresented their intentions are the "moderates," who claimed to support reform, but clearly don't."

Look harder.

We've got a philosophical difference, which we've debated repeatedly, and that is that Senator Clinton believes the only way to achieve universal health care is to force everybody to purchase it. - February 21, 2008
posted by Joe Beese at 10:46 AM on November 22, 2009 [2 favorites]

I've now decided that it is literally more realistic for me to build a spaceship and go live on Mars than that the US will end up with some kind of useful universal healthcare, like the rest of the non-barbarian world has, I'll see you motherfuckers later.
posted by Divine_Wino at 10:47 AM on November 22, 2009 [4 favorites]

- ... insurers are still allowed to deny claims, and two industry whistleblowers... have testified before Congress that the industry is now so sophisticated in its ability to deny claims, control care, and cherry-pick that these protections are essentially worthless.

Denying medically-unnecessary, erroneously- or fraudulantly-billed claims is one of the most of the effective ways to control healthcare costs. As unpleasant as that is, it is just a fact of healthcare economics. Guess who does it best?
posted by njbradburn at 11:02 AM on November 22, 2009

More and more, I see Obama as America's equivalent of Mikhail Gorbachev. Gorbachev was a proud Communist, trying to reform a system that was beyond repair. What Gorby had in his favor was a one-party system, lacking an unaffiliated organization even more dedicated to protecting the status quo than those in power, not to mention the fact that the U.S. has long had corporate power structures not too dissimilar from those that rose in Russia after the Fall of Communism. But Obama's faith in the American System is just as tragically misplaced... his definition of Change is necessarily narrow, and less well-defined than Glasnost and Perestrioka were. So the U.S.A's inevitable fall may be even harder than the U.S.S.R.'s was (we have even farther to fall, even after three decades of decline, but we have more of a cushion of genuine assets - and not just financial ones).

It must be declared that neither Big Government nor Big Private Enterprise are by their nature bad, but both are very vulnerable to corruption. And America has done a better job policing its Government than its Corporations (but not good enough of either). I think that is why we had such high hopes for companies like Google and Apple to be Good Corporate Citizens, but it has become more obvious every day that they have failed.

When it comes to building a system that provides Health Care to America, the Insurance Industry is the worst possible choice for the job (which I have learned to my amazement is a belief shared by almost every person I know who has worked in some other part of the Insurance Industry). And the whole concept of tying Health Care to employment was good for the building of a Union Labor Movement and workers' rights in general many decades ago, but badly fails the true Individual Entrepreneur (who goes "into business" not to build his/her own Corporate Empire but just to be "my own brand"). Any hope for a truly better system will probably require a catastrophic collapse first... so if 'Obamacare' fails to prevent such a collapse, it may work out better than if it hadn't, but this is absolutely NOT the end of the Hard Times...
posted by oneswellfoop at 11:07 AM on November 22, 2009 [8 favorites]

> How about health insurance when you never get sick?

Unless you have an internet connection from beyond the grave, you can't yet say that you never get sick. You may yet, God forbid, get sick. You may also get hit by a bus.

The biggest sellling point about universal, single payer health care (if you aren't warm to the ethical/moral dimension) is that per service, per person, it COSTS LESS to deliver than under the current US system. Beyond the obvious savings of insurance company overhead and profit, a single payer is far more effective in negotiating prices.

But it seems that Americans would rather keep paying more to the private healthcare system than -gasp- have any of their tax spent on a poor person. (As if it wasn't already)
posted by Artful Codger at 11:16 AM on November 22, 2009 [2 favorites]

>: Major concessions extracted by holdout senators.

By the time this bill passes there's going to be so many concessions that the bill's going to
a)completely suck
b)have nothing to do with healthcare.

What's the fucking point if it doesn't provide universal healthcare? Oh, wait, the Obama administration already said that was off the table.
posted by dunkadunc at 11:24 AM on November 22, 2009 [2 favorites]

I'm agreeing with you that the constitution doesn't give the federal government the right to tax income.

What?

I'm not trying to derail the thread here, but... what?
posted by XQUZYPHYR at 11:30 AM on November 22, 2009 [3 favorites]

But it seems that Americans would rather keep paying more to the private healthcare system than -gasp- have any of their tax spent on a poor person. (As if it wasn't already)

*/smiles. That may well be the case. And this moment in time makes me think that much of Europe is looking at us now with the same sort of exasperation and "What the hell is *with those people??" sentiments that they had in the late 19th century. It sounds so easy and obvious--health insurance for everyone. And the concept--the moral imperative--is an easy one for everyone in this country to get behind. At every economic level, across the political spectrum, no one wants to deny healthcare to anyone. No one in this country is a monster.

The proposed plan for changing the existing system of public and private healthcare financing isn't *simply about spending money on poor people. And anyone who oversimplifies the response in an ignoramous and an asshole. It's about the character of the nation. If we could have a president who actually knew something about how to pitch a program of this magnitude to the people, so that this thing didn't come off as Nancy Pelosi trying to turn us Pinko, we might be on the road to reform already.
posted by njbradburn at 11:36 AM on November 22, 2009 [1 favorite]

I suspect justkevin meant "I'm arguing with you" and wrote "I'm agreeing with you" instead.
posted by argybarg at 11:41 AM on November 22, 2009

You can dismiss me as just another "sky is falling" liberal, but day by day it is becoming clearer that this country is a plutocracy. Honestly, if corporate interests are more important than the health of the public, what does that say about us?
posted by MattMangels at 11:56 AM on November 22, 2009 [1 favorite]

>...the concept--the moral imperative--is an easy one for everyone in this country to get behind. At every economic level, across the political spectrum, no one wants to deny healthcare to anyone.

... horseshit. Next dinner party you throw, just murmur "health care for illegals" and watch the fun.

Most Americans can get behind life, liberty and the purfuit of happineff, but for some reason they draw the line at health care.

> The proposed plan for changing the existing system of public and private healthcare financing isn't *simply about spending money on poor people. And anyone who oversimplifies the response in an ignoramous and an asshole. It's about the character of the nation.

I resemble that remark.

I know that, and you know that. Yet the people against health-care-tinancing reform have successfully raised the spectre of soshulizm, with side orders of rationing and death committees. The real issues have successfully been obscured.

If the current bill ain't it, what measures could possibly achieve reform and still satisfy the national character?
posted by Artful Codger at 12:03 PM on November 22, 2009 [1 favorite]

Yet the people against health-care-tinancing reform have successfully raised the spectre of soshulizm, with side orders of rationing and death committees. The real issues have successfully been obscured.

Don't forget abortion. But come on — did you think the opposition was just going to forget to use these attacks? The real issues have been obscured because our legislators have allowed them to be obscured. The script has been tediously predictable, particularly the part where the alleged "progressives" are falling over backwards to dissociate "health care reform" from progressive economic policies, access to abortion and birth control, humane immigration policies, or any of the other things which they ostensibly support yet are unwilling to openly defend in this context out of sheer white-knuckled fear of Republicans. Maybe they'd get somewhere if they'd stand up for something just one fucking time instead of constantly struggling to justify their position on the grounds that it's not as strong as the opposition claims. What kind of fight is that? Fuck, if you're going to lose the fight for universal health care anyway, why not lose the fight where you call it the Eugene Victor Debs Memorial Workers' Brotherhood of Health and there are little cartoon fat cats with dollar signs for eyes getting walloped on the stationery.
posted by enn at 12:21 PM on November 22, 2009

If the current bill ain't it, what measures could possibly achieve reform and still satisfy the national character?

I should have said that the *panic over the proposed plan to change the current public/private system...but you probably figured that out. What would achieve it? Thanks for asking!

Allow people with health insurance through their employer to keep it. Focus on enrolling people eligible for Medicare and Medicaid and SCHIPs. Allocate public funding to beef up those safety net programs for people who lose coverage.

I've spent a long time working where supply meets demand on this issue--so many people qualify for coverage, but either either aren't aware of the program or don't have there wherewithal to fill out the forms until they end up in the ER and someone helps them get enrolled in Medicaid. "But Medicare and Medicaid are public programs," someone may sneer. Yes, and when someone is part of the system, they may have a better chance of getting regular care that will control their diabetes or CHF that landed them in the ER with an acute issue. Better for the patient, for the hospital, better use of resources. We have a system. It isn't appropriately organized, the public financing programs are certainly underutilized, and the incentives are misaligned. But a radical overhaul isn't appropriate, in my opinion, when dealing with an industry the size and scope of healthcare.
posted by njbradburn at 12:43 PM on November 22, 2009

Yes, you caught me being disingenuous. I was pointing out that Balisong's argument that the federal government had no constitutional authority imposing fines for failure to purchase health coverage is the same argument the "income tax is unconstitutional" advocates throw out there.

The income tax laws include all sorts of penalties and incentives to discourage and encourage particular behavior. This bill isn't breaking any constitutional ground there.
posted by justkevin at 12:49 PM on November 22, 2009

We have a system. It isn't appropriately organized, the public financing programs are certainly underutilized, and the incentives are misaligned. But a radical overhaul isn't appropriate, in my opinion, when dealing with an industry the size and scope of healthcare.

As simple as that? Whew. I was worried that there was some issue with the cost of health care delivery overall, that insurance companies were refusing to enroll people with pre-existing conditions, that health-care benefits were locking people into jobs they hated, that serious illness was the leading cause of personal bankruptcy, and that physicians were spending north of 20% of their times filling out insurance forms and fighting insurers on claims.

Boy was I wrong. That's a load off, fer shurr.
posted by Artful Codger at 12:54 PM on November 22, 2009 [4 favorites]

Best politicians money can buy...
posted by Jimbob at 1:05 PM on November 22, 2009

At every economic level, across the political spectrum, no one wants to deny healthcare to anyone. No one in this country is a monster.

Oh yeah? Then answer me this: who pays for abortions?

It's a medical procedure, after all. It can even be a life-saving measure. Yet there are people who would rather have no free health care, that would rather watch someone die than have a single penny of "their tax dollars" pay for baby-killin'. That's the kind of stupidity we're up against. You can't have stupidity like that and not have a fair share of monsters by proxy.
posted by Civil_Disobedient at 1:14 PM on November 22, 2009 [5 favorites]

Guess who does it best?

As a guy who's worked in property claims, I'd imagine there's other reasons as well why Medicare has a higher percentage of denials. Brokers and insurance companies will often convince a potential claimant not to make a claim and pay out of pocket rather than have their premiums go up, which likely skews the numbers a bit. Claims that might not fit a private insurer's criteria for something that will get reimbursed never become proper claims at all and therefore they never get officially "denied".

Not to say it's not a good point you're making, but my suspicion is that the structure of a public health insurer wouldn't require it to actively discourage people making questionable claims to the same extent a private one would, and might deny such claims outright with little consequence to the claimant (i.e. increased premiums).
posted by Hoopo at 1:39 PM on November 22, 2009

At every economic level, across the political spectrum, no one wants to deny healthcare to anyone. No one in this country is a monster.

Dude, you are so not living in the reality that the other several hundred million of your countrymen are living in. You just might want to open your eyes a peep. Being blind to the situation isn't going to help you.
posted by five fresh fish at 2:37 PM on November 22, 2009

So long as the words "insurance companies" continues to be used in the healthcare bill, all y'all are going to have lousy healthcare. Involving the insurance companies requires a 20% overhead be added to all bills; and requires the insurance companies to actively work toward dismissing claims. The former makes universality too expensive to provide; and the latter makes it all pointless anyway.
posted by five fresh fish at 2:49 PM on November 22, 2009 [3 favorites]

Not to say it's not a good point you're making, but my suspicion is that the structure of a public health insurer wouldn't require it to actively discourage people making questionable claims to the same extent a private one would, and might deny such claims outright with little consequence to the claimant (i.e. increased premiums).

Single data point: I went to the doctor 3 times last year and filed 3 Medicare (Australia) clams and my Medicare levy didn't change.

I even filed a claim with my private insurer (lolwut private insurance in single payer? Yes it does exist) and haven't had my extremely modest premiums rise by any more than the government mandated amount.
posted by Talez at 2:56 PM on November 22, 2009

Not to say it's not a good point you're making, but my suspicion is that the structure of a public health insurer wouldn't require it to actively discourage people making questionable claims to the same extent a private one would, and might deny such claims outright with little consequence to the claimant (i.e. increased premiums).

Hoopo, actually, my only point was that our government insurer-Medicare-denies claims all the time, so anyone who is supporting reform thinking that the government system that emerges will cover everything is misinformed. There is so much rhetoric about "evil insurance companies denying claims," that I thought I could balance the picture with our own Federal program's track record for denying claims. There are many reasons for denying a claim. It is noted that the bill still allows private insurers to deny claims, because the public system will have to deny them as well.
posted by njbradburn at 4:07 PM on November 22, 2009

That article about claim denial hides more than it reveals. Not surprising considering the source.

Medical claims range from remove my wart to quintuple cardiac bypass. As do the reasons for claim rejection. The cited source of the statistics is the AMA's 2008 National Health Insurer Report Card. Warning. requires analysis and thinking.

I got the following from that AMA document:
- about 62% of the Medicaid rejections were for one of the following reasons:

*Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).
*These are non-covered services because this is not deemed a ‘medical necessity’ by the payer.
*Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.

In fairness, the majority of rejections across all surveyed providers was mostly for administrative minutae. Still alot of deeper info hidden. Like how many rejections led to complications or death.

- in categories with record counts, Medicare usually had 8 times the records of the largest private insurer. To me that says that Medicare handles 8 times the throughput of the largest private insurer with performance metrics matching the private insurers. Suck on that, government-haters.

But what really struck me was the sheer bureaucracy of it all, Medicare or otherwise. Here in Canada, my doctor (the one I chose, btw) makes the call as to whether a treatment is required and it happens, end of story. I don't have to do anything, fill out anything, get preapproved.

When I hear about what Americans have to go through to arrange for and receive healthcare, and the astonishing number without healthcare, I feel like Americans must feel like when they hear about people in a dictatorship, or who are being denied democracy. How does this happen in a rich civilized country?
posted by Artful Codger at 7:21 PM on November 22, 2009 [3 favorites]

One more mini-rant: NO single system is going to cover 100% of all possible medical demands. The single-payer system covers the essential and basic needs - all routine check-ups and physicals, and any essential or serious treatments to maintain health. For everyone.

The government-haters ignore the fact that private insurers DO have a role in Canada's single-payer system system - most employers offer a benefits package from a private insurer that provides for enhanced or top-up services. Things like: dental, prescription costs, private room, auxialiary care like extended physio, rehabilitation or massage, medical appliances and retrofits, disability benefits.

The difference? A private insurer isn't blocking or controlling access to basic healthcare.
posted by Artful Codger at 7:49 PM on November 22, 2009 [2 favorites]

It sounds so easy and obvious--health insurance for everyone. And the concept--the moral imperative--is an easy one for everyone in this country to get behind. At every economic level, across the political spectrum, no one wants to deny healthcare to anyone. No one in this country is a monster.

This is not true. I know quite a few conservatives, and every one of them (politics come up a lot, so I do mean this) openly and unabashedly will tell you that they do not believe healthcare is something people have a right to. If you counter that being people shouldn't die simply because they are poor they generally will either spout off some story about how someone they knew was poor and now isn't, so no one has any excuse to be poor, or they will vehemently deny that people die because they are poor. If you pressure them enough, and maybe use slightly different language, they will admit to a belief that being poor means you deserve to die of a treatable medical condition.

There are plenty of monsters in this country.
posted by !Jim at 12:00 AM on November 23, 2009 [8 favorites]

I'll see you motherfuckers later.

Same here. I've submitted all my paperwork to obtain nursing licensure in Canada. At this point I'm honestly ashamed to be a health care worker in the US and want nothing to do with this system any longer.
posted by makonan at 1:43 AM on November 23, 2009 [3 favorites]

Tea partiers heckle woman whose daughter-in-law died because she didn’t have health insurance.
posted by homunculus at 8:18 PM on November 24, 2009