HCR: Naughty or Nice?

December 24, 2009 7:23 AM

Landmark health care reform legislation passes senate on a Christmas-eve party line vote. So after a turbulent and contentious legislative process with many sudden reversals and last minute surprises, what's actually in the bill? NPR offers a "Consumer's Guide" to the form the final, reconciled legislation now seems likeliest to take.

President Obama speaks with Jim Lehrer about the final outcome of the legislative process. Also: An interactive history of the dismal, century-long history of health care reform in America. (Interestingly, even while advancing the sweeping reforms of the New Deal era, FDR reportedly decided not to take on the issue of health care reform, citing the political challenges). For bonus points: Compare and contrast the current health care reforms with those championed unsuccessfully by the Clinton administration in 1993.

posted by saulgoodman (111 comments total)

It would have been nice to provide insurance for uninsured people but if they couldn't manage that you'd have thought at least they could have let them stay uninsured for free. I guess those seven-figure salaries at AIG and Goldman aren't going to pay themselves.
posted by enn at 7:28 AM on December 24, 2009 [8 favorites]

"Some would be exempted from the requirement, called an individual mandate, due to financial hardship or religious reasons."

So I assume the Southern Baptist Convention/National Association of Evangelicals will be releasing a ruling that they object to government mandated health care and their membership should be exempt from being forced to purchase individual mandates?
posted by PenDevil at 7:29 AM on December 24, 2009

My favorite part is that the government picks up the tab if costs exceed a calculated amount. Okay, so there's absolutely no disincentive for insurers to charge as much as they want, because tax money will make up the difference! Yay! It's like socialized medicine except that there's a 30% graft for insurance companies.

Fuck this bill, and fuck the people who passed it.
posted by TheNewWazoo at 7:32 AM on December 24, 2009 [21 favorites]

at least they could have let them stay uninsured for free.

But being uninsured is not free, no more than uninsured driving is free. Not having insurance only externalizes the costs. Providing health care to the uninsured costs us billions.

"Some would be exempted from the requirement, called an individual mandate, due to financial hardship or religious reasons."

I think this means Jim Henson wouldn't have to buy insurance, were he alive today.
posted by saulgoodman at 7:34 AM on December 24, 2009 [3 favorites]

Actually, it does, with heavily subsidized insurance plans including at least two that are in every "insurance exchange" that are government mandated, one of which would also be required to be a non-profit.

This is taking the approach Hawaii did - make healthcare mandatory and affordable. Not ideal, but a solid step in the right direction, and lightyears better than "nothing." The next step would be to tighten up the loopholes that let small businesses off the hook... and beyond that, the groundwork for a single-payer system may still be in the cards, depending on how the 2010 and 2012 elections go, and how successful the non-profit plans are or aren't.
posted by Slap*Happy at 7:35 AM on December 24, 2009 [10 favorites]

But being uninsured is not free, no more than uninsured driving is free. Not having insurance only externalizes the costs. Providing health care to the uninsured costs us billions.

That's true, but it's far more expensive to let people go uninsured, and it's inhumane. Since you can't get blood from a stone, the money has to come from somewhere, such as the people who can afford it.

Going to Iraq and Afghanistan cost us ~$1 trillion. Our priorities are not straight.
posted by krinklyfig at 7:40 AM on December 24, 2009 [4 favorites]

On the plus side, we have four years or so to add on a public option and/or Medicare expansion before most of it goes live. Perhaps if the Democrats do well in 2010 and 2012.

Then again, the Republicans have been really good at stirring up their base, so who knows. I doubt they'll get the numbers they need to scrap the bill like Newt Gingrich has been claiming he'd do.

Also, HURF DURF FUCK LIEBERMAN. The Medicare buy-in was the perfect compromise, and he knew it. He just wants to get a good job with a lobbying firm, and he puts his own career above the American people.
posted by mccarty.tim at 7:42 AM on December 24, 2009

is this coal? it tastes a bit like coal. thanks guys. sigh.
posted by Potomac Avenue at 7:46 AM on December 24, 2009 [4 favorites]

I heard a sound bite on NPR yesterday from one of the the Republican leaders (I think it was Lindsey Graham) The gist was that healthcare reform would mark the end of Republican bipartisanship here on. I heard this and broke my brain trying to recall even 60 consecutive seconds throughout this whole mess when the Republicans even approached an actual bipartisan stance.
posted by Thorzdad at 7:47 AM on December 24, 2009 [19 favorites]

"Actually, it does, with heavily subsidized insurance plans including at least two that are in every "insurance exchange"

And who will run these plans, these that are heavily subsidized? Presumably the same companies who also run for-profit enterprises now, or the same non-profits that charge the same damned rates as the for-profits (e.g. Kaiser)? This plan does not remove the anti-trust exemptions, nor does it restrict administrative overhead costs, nor does it require slowing increases in plan costs, etc, etc.

The simple fact is that once a buyer passes a certain "magic line", the insurance companies have a no-risk cash cow to milk right along with this huge new compelled customer base and it's going to come from my pocket.

I love paying taxes, because it buys me civilization. I hate paying extortion, because it buys me the right be extorted more.
posted by TheNewWazoo at 7:48 AM on December 24, 2009 [9 favorites]

Healthcare stocks have appreciated nicely, which should tell you all you need to know about who benefits from this legislation.
posted by Blazecock Pileon at 7:49 AM on December 24, 2009 [12 favorites]

Paying for wars they oppose? Healthcare oppose? My guess this is going to be 100x worse. Why would I want to buy something that I don't want or be penalized for failing to do so? Unconstitutional authority where they know it, but decide to screw the rest of the country and throw a bone to Nebraska, Montana, and all of the me first Senators. FUCK YOU! Reid. This is not how government is supposed to opperate. This first step in government take over in your private lives whether you like it or not and no one seems to realize that.
posted by brent at 7:49 AM on December 24, 2009

>Going to Iraq and Afghanistan cost us ~$1 trillion. Our priorities are not straight.

This. For all their "fiscal responsibility," the most vocal people against HR in general have a huge blindspot. The Bush tax cuts cost twice as much as a public option would have.

And for all they hate a deficit when a Democrat's in power, heaven forbid there be a tax on anything or a cut to Medicare or military spending! What are they hoping Obama do, other than fuck over the poor? Do they want him to find gold on government owned land?

I bet they'd gripe about that, too, and say that we should give it away to a private mining company because free enterprise built this nation. They want the country to suffer under Obama. They don't want a balanced budget. They just want to bug him. If he were paying off the national debt, they'd prattle on about how we need to use our massive national credit to pay for military operations that will lead to world peace, less WMDs, or Israel acting out the events in Revelation or whatever.

I'm sure the GOP was started on great principles, but it's now a party of spite. Lincoln would be a Democrat, and Reagan would hate him.
posted by mccarty.tim at 7:51 AM on December 24, 2009 [17 favorites]

the money has to come from somewhere, such as the people who can afford it.

Well, in fairness, it's supposed to be coming from people who can. The point of the subsidies for lower income households is to put most of the burden on those earning more, who presumably can afford it. The mandate is essentially a tax increase to pay for expanding coverage to the high risk, which is what we would have ended up with anyway, though through a different mechanism, in virtually any other scheme. The biggest weakness of the current reform is not so much it's impact on those on the lower end of the economic scale (who would actually see the bulk of the benefits) as it is the fact that the legislation arguably doesn't go far enough to control costs (which could cause the Federal outlay for subsidies to swell as costs continue to grow).
posted by saulgoodman at 7:52 AM on December 24, 2009

From the NPR guide:
Both the House and Senate would place new fees on the medical device industry, health insurers and tanning salons...

wut
posted by nomad at 7:55 AM on December 24, 2009

D'oh.

Turns out I misread: "the money has to come from somewhere, such as the people who can afford it." as: "the money has to come from somewhere, such as the people who can't afford it."

Sorry. Carry on then.
posted by saulgoodman at 7:57 AM on December 24, 2009

Perhaps if the Democrats do well in 2010 and 2012.

Or 2006 and 2008, as we heard them say in 2005 and 2007. I'm a little tired of them having a majority without actually using it. It's high time the Democrats act like a majority because the chances that the solid red southern and western Senate seats ever turning blue are slim. You go tho the senate with the majority that you are given, not with the one you wished you had.
posted by kuujjuarapik at 8:00 AM on December 24, 2009 [2 favorites]

Well, in fairness, it's supposed to be coming from people who can.

Right, because if there's a sure sign you've got too much spare cash sloshing around, it's that you don't have health insurance. Give me a fucking break.
posted by enn at 8:04 AM on December 24, 2009

I hate Liberman, Nelson, and the Republicans, as any good lefty should, but look: It seems to be a good first step. I'm reminded of the first civil rights legislation Johnson as Senator pushed through, which was expanded upon in the sixties. To those who are hating on Reid: What exactly was he supposed to do to get his sixty votes?
posted by angrycat at 8:04 AM on December 24, 2009 [6 favorites]

At this point, the filibuster is starting to look ridiculous. Does anyone have any examples of when it's (effectively) been used for good? Under Bush Jr., we still gave the Republicans 90% of what they wanted, just because they threatened to get rid of the filibuster.
posted by mccarty.tim at 8:06 AM on December 24, 2009 [1 favorite]

I'm a little tired of them [the Dems] having a majority without actually using it.

I agree. and I think that they need to just let the Repubs filibuster and filibuster. Make them actually have to keep talking. Make them follow through on their threat. Let the American public hear on the news every day "and the Repubs continued with their filibuster today" over and over. Heck, if the Dems had just let the Repubs filibuster, they could have likely had the health insurance bill that the Dems wanted, because it's now Christmas break, and there's no way the Repubs would have wanted to keep going with their nonsense through the holiday, so they would have had to vote to allow things to proceed in order to go home, and then the Dems could have immediately passed the bill with the majority they have.

The idea that it "requires" 60 votes to pass something in a majority wins body is ridiculous.
posted by hippybear at 8:07 AM on December 24, 2009 [17 favorites]

The mandate is essentially a tax increase to pay for expanding coverage to the high risk, which is what we would have ended up with anyway, though through a different mechanism, in virtually any other scheme.

Yeah, I know.

However, I keep reminding myself that universal health care in most other countries came about through incremental change. But we do seem to be taking our time getting there.
posted by krinklyfig at 8:08 AM on December 24, 2009

it's that you don't have health insurance. Give me a fucking break.

If you don't have cash sloshing around in your pockets, this bill will pay for your insurance. That's in the bill, so don't ignore it. The real problem is just that there's nothing to keep the costs the government has to pay down, which is good for insurance companies, but not necessarily the federal budget.
posted by saulgoodman at 8:08 AM on December 24, 2009 [2 favorites]

To be clear: I don't hate Ried. I hate what Lieberman and Nelson have done. I hate the filibuster system that means any senator who steps out of line effectively gets his pony from Ried, and becomes a hero to at least 40% of the nation.

We've got a system that rewards people who don't want to cooperate. This isn't working towards compromises. This is working towards back-room deals and the dirtiest of politics.
posted by mccarty.tim at 8:08 AM on December 24, 2009 [5 favorites]

I'm a little tired of them having a majority without actually using it. It's high time the Democrats act like a majority...

See, the problem is that, unlike the Republicans, the Democrats are a much more diverse "big tent" party. A loose organization where disparate factions come together at different moments.

Think of the Dems as a really messy Venn diagram. There's rarely a point were ALL of the components overlap.
posted by Thorzdad at 8:10 AM on December 24, 2009

We have had mandated health care here in Massachusetts ever since our then Republican Governor Mitt Romney pushed for and signed the The 2006 Massachusetts Health Care Reform Law. Commonwealth Connector is the state agency "managing mandatory health insurance. "Key provisions of the law include subsidized health insurance for residents earning less than 300% of the Federal Poverty Level, and low-cost insurance for all other residents who are not eligible for insurance through their employers." The two basic programs are Commonwealth Care, for lower income residents, and Commonwealth Choice, which offers private sector alternatives for those who don't qualify for low-income insurance.
posted by ericb at 8:11 AM on December 24, 2009 [1 favorite]

Ezra Klein -- "Winning Ugly, But Winning" (Washington Post)

Jonathan Chair -- "And the Rest is Just Noise" (The New Republic)

I found these two articles, both rec'd by Nate Silver (who has also been a reassuring voice) fairly convincing that there is more to celebrate than bemoan at this moment.
posted by fourcheesemac at 8:11 AM on December 24, 2009 [9 favorites]

If you don't have cash sloshing around in your pockets, this bill will pay for your insurance.

Up to 400% of the poverty line, above which you can be forced to pay up to 8% of your income just in premiums — never mind the additional costs for copays and deductibles and uncovered care. That's not progressive enough.
posted by enn at 8:13 AM on December 24, 2009 [1 favorite]

>I agree. and I think that they need to just let the Repubs filibuster and filibuster. Make them actually have to keep talking. Make them follow through on their threat.

The filibuster is so institutionalized, they don't even have to talk. They just need to ask for one, and the floor is held up with no speaking. Of course, the senate majority leader could demand that they actually speak, but I don't think Ried's that assertive. Could you imagine Glenn Beck talking about how mean old Harry Ried forced a bunch of aged Republicans with sore throats to talk when they were forced to work IN THE CHRISTMAS SEASON? And then they went to the doctors on their GOVERNMENT INSURANCE, but then the doctors said they couldn't suggest anything but tea and honey? AND THAT THAT'S EXACTLY WHAT OBAMACARE WOULD BE?
posted by mccarty.tim at 8:13 AM on December 24, 2009 [2 favorites]

If a follow-up bill can apply cost controls on the healthcare industry, that's probably the only way this law doesn't eventually get overturned for costing too much.
posted by Blazecock Pileon at 8:13 AM on December 24, 2009

but but but but - the bemoaning!
posted by The Whelk at 8:13 AM on December 24, 2009

It's about time we made some progress to catch up to every other civilized nation in offering basic health care to our people - and we have a long way to go. I keep telling myself that this is the first step - when I hear that it took several attempts to pass civil rights laws, I believe and hope that will be the case with health reform.

We still need a public option. We still need a fair price on drugs - achievable if our government can buy in quantity for those in need and from sources that are reasonable not profit hungry.

We still need a mandate for people to pay into the system, with subsidies for those in need, but tapping into the resource that young, healthy people offer by paying into a system they don't yet need to help those less fortunate and needy. This is the right thing to do.

When did our beautiful country change from being kind and decent to exalting greed and special interests? I recall strong reactions to the Wall Street movie in which Michael Douglas said "greed is good". A million years from the credo that more is less, less is more and we are all our brother's and sister's keeper. Basically, I believe in the golden rule and being fair and honest. And caring about people rather than finding reasons to hate, hurt or ignore them.

How galling that those most opposed to health reform really can't stand the idea of those with the most wealth helping out those with so much less. Taxing people with over $500000 salaries is a reasonable way to pay for this, along with cost cutting measures including fair prices for drugs and mandated pay in-s. Plus I heard about an elderly woman getting a pap smear while dying with kidney and heart failure. That doctors perform needless tests and procedures constantly all spiking costs without benefit to patients - a real thievery that must be stopped.

I am reminded of Les Miserables where a man steals bread and winds up in prison while rich folks who really steal and live off others can't away with their selfish exploitative ways.

Come on America - let's be fair. In England people are taxed 40% on bonuses over $50,000 while our Wall Street bullies rake in tons more without little or none of it going to the very needy including the drowning middle class fast sliding into the lower paycheck-to-paycheck segment of our society.

When multi-billionaire Warren Buffet observed that his secretary pays more taxes percentage-wise than he does, an alarm bell should go off and not stop till such inequities are dealt with.

I wish you all a merry and enlightened holiday season leading to a greater awareness and compassion for others in 2010. I love the idea of modest needs - giving a few dollars to those with stated needs - a very touching and effective way of helping others which I will engage in and encourage others to do as well.

If this idea is replicated and followed by those all along the economic ladder what a tremendous difference that would make and an immediate one. I will hope for this and watch for it too. Peace.
posted by JeanneCasatelli at 8:15 AM on December 24, 2009 [4 favorites]

Jonathan Chait, not Chair.

Oh, and Nate Silver says:

Health Insurance Stocks Decline on News of Senate Passage of Reform Bill; Have Underperformed Market Since Start of Week

Also, his "Another Left Right Convergence" from earlier in the week is terrific.

My favorite activist blogger, Al Giordano, also had a strong piece on the subject a few days back.
posted by fourcheesemac at 8:15 AM on December 24, 2009 [2 favorites]

To raise money to pay for the legislation, the Senate would place a 40 percent tax on the portion of most employer-sponsored health coverage that exceeds $8,500 a year for individuals and $23,000 for families. (NPR Consumer Guide)

It would seem that many employers would respond to this by either passing on the cost to their employees or choosing cheaper plans with reduced benefits. I'm not sure I like that.
posted by DWRoelands at 8:21 AM on December 24, 2009

In Senate Health Care Vote, New Partisan Vitriol

"The votes also marked something else: the culmination of more than a generation of partisan polarization of the American political system, and a precipitous decline in collegiality and collaboration in governing that seemed to move in inverse proportion to a rising influence of lobbying, money, the 24-hour news cycle and hostilities on talk shows and in the blogosphere.

The health care legislation was approved Thursday morning, with the Senate divided on party lines — something that has not happened in modern times on so important a shift in domestic policy, or on major legislation of any kind, lawmakers and Congressional historians said.

...Many senators said the current vitriol, which continued on the floor on Wednesday with a fight over when to cast the final health care vote, was unlike anything they had seen. “It has gotten so much more partisan,” said Senator John D. Rockefeller IV, Democrat of West Virginia. 'This was so wicked. This was so venal.'

Even in a bitter fight over President Bill Clinton’s budget in 1993, decided 51 to 50 with a rare tie-breaker vote by Vice President Al Gore, the partisanship was not as stark as it is today.

Ross K. Baker, a political scientist at Rutgers University and an expert on the history of the Senate, said that in earlier eras, senators would routinely cross party lines to vote in favor of major legislation on issues like civil rights and social welfare policy.

...'It certainly is a culmination of a long period of intensifying political polarization,' Mr. Baker said of this year’s showdown over health care. 'It has gotten so bad now that Republicans don’t want to be seen publicly in the presence of Democrats or have a Democrat profess friendship for them or vice versa.'

...But even as senators complained about the rancor and expressed nostalgia for a kinder era, they conceded that the hyper-partisanship was likely to continue, potentially coloring coming debates on other major issues including financial regulation, climate change and, perhaps, immigration."

posted by ericb at 8:21 AM on December 24, 2009

there is more to celebrate than bemoan at this moment

The Manager’s Amendment includes important features that will move our nation’s health care forward while helping to control health expenditure growth.
posted by preparat at 8:21 AM on December 24, 2009

WAY BACK MACHINE--DURING THE 60, THE SAYING:
if you ain't part of the solution you are part of the problem

what did you do to make your voice heard? did you write your congress folks? Sign petitions?
call to ask support for a position?

If not, then easy to sit back and carp, bitch, be snarky, clever, sarcastic.

Recall a bit of history: slavery became segregation became equal rights--not always perfect and not fast enough. But evolved in the right direction once it began.
posted by Postroad at 8:30 AM on December 24, 2009

My suspicion of this whole boondoggle is way high. Anything that jacks insurance company stocks can't be a good thing for normal folks...

What I'm thinking we're going to get is a bizarre catastrophic plan framework. We pay a hefty chunk of income every month and we get a shit plan that covers nothing EXCEPT for 5000/10000 catastrophic coverage limits.

It's win win for insurance companies. The majority of shit isn't covered since it's under the deductible. The high dollar catastrophic stuff is subsidized by the government. Think of it as TARP for insurance.

<1>10000 is covered but paid by the govt.


I haven't a clue if this is a correct appraisal, but that's what it looks like at first glance...

And for the record, it sucks. I already have this kind of insurance. I call it the insurance that doesn't pay for anything but costs a lot of money. Not hugely useful.
posted by Lord_Pall at 8:40 AM on December 24, 2009

>Both the House and Senate would place new fees on the ... tanning salons...

Clearly, a partisan attack on John Boehner.
posted by mccarty.tim at 8:42 AM on December 24, 2009 [2 favorites]

Right, because if there's a sure sign you've got too much spare cash sloshing around, it's that you don't have health insurance. Give me a fucking break.

I think you misread me.
posted by krinklyfig at 8:45 AM on December 24, 2009

My suspicion of this whole boondoggle is way high. Anything that jacks insurance company stocks can't be a good thing for normal folks...

I think that reading the goodness or badness of political decisions via short-term movements of the inherently chaotic stock market is less than completely sensible, but if you insist, as fourcheesemac mentioned above, Health Insurance Stocks Decline on News of Senate Passage of Reform Bill; Have Underperformed Market Since Start of Week.
posted by Flunkie at 8:45 AM on December 24, 2009

I agree that it's a good first step. It's a real accomplishment. One that republicans know is problematic for them.
posted by uraniumwilly at 8:47 AM on December 24, 2009 [1 favorite]

I don't get the reduction to the price of insurance company stocks. It doesn't at all tell us what we need to know to know that they rose or fell on short-term news. (And as Silver says, linked above, actually the fell this week.)

Health policy reform entails spending money. That is done in the private sector and, alas, that will continue to be the case for health care. Insurance companies just acquired 30+million new customers and a more predictable regulatory environment. Providing care to millions more people is not a change in the growth of spending, only its level. The idea is that it will reduce growth rates in medical costs. When we pass defense spending, defense contractors benefit and their stocks rise. Same for infrastructure spending. We are just about to commit hundreds of billions in new and redirected funding to health care, managed by insurance companies. Insurance companies ought to be happy and their stocks ought to rise. They're entitled to run their businesses honestly and fairly. Since they add no value other than managing money, they should be able to do quite well with a 15 percent profit margin as a guaranteed MCR.

It's too simple to say "if it's good for them it's bad for people." What they had was unequivocally that already. This is -- and this is the point -- something of a shift on that axis, maybe a significant one. A long time coming.
posted by fourcheesemac at 8:47 AM on December 24, 2009 [2 favorites]

I agree. and I think that they need to just let the Repubs filibuster and filibuster. Make them actually have to keep talking. Make them follow through on their threat.

That's actually what happened. The Republicans caved, which is why they ended up voting on it.
posted by krinklyfig at 8:48 AM on December 24, 2009

I agree. and I think that they need to just let the Repubs filibuster and filibuster. Make them actually have to keep talking. Make them follow through on their threat.

That's actually what happened. The Republicans caved, which is why they ended up voting on it.

The Republicans didn't cave. Not one member of the Republican Party voted for cloture. Not one.
posted by Flunkie at 8:51 AM on December 24, 2009

To those who are hating on Reid: What exactly was he supposed to do to get his sixty votes?

Strip Lieberman of his committee chair in response to his opposition. Call Nelson's bluff and force him to fillibuster with the Republicans for a few days. Point out on national television how much money each recieved from the industry. In general, create a political cost for being on the wrong side, and reduce political costs for being on the right side. Reid failed to do that. Obama did too.
posted by scottreynen at 8:53 AM on December 24, 2009 [11 favorites]

I don't get the reduction to the price of insurance company stocks. It doesn't at all tell us what we need to know to know that they rose or fell on short-term news. (And as Silver says, linked above, actually the fell this week.)

UNH has been up over 12% since the Senate made it clear they were not including a public option nor a Medicare expansion.
posted by krinklyfig at 8:53 AM on December 24, 2009 [1 favorite]

To those who are hating on Reid: What exactly was he supposed to do to get his sixty votes?

Strip Lieberman of his committee chair in response to his opposition.

I genuinely have no idea how you imagine that that would make it more likely for Lieberman to vote for cloture.
posted by Flunkie at 8:54 AM on December 24, 2009

The Republicans didn't cave. Not one member of the Republican Party voted for cloture. Not one.

They could have kept filibustering, but they made it clear to Reid that they were quitting on Xmas Eve, and he announced it to the full Senate. Previously they had vowed to keep going until Valentine's Day and beyond.
posted by krinklyfig at 8:55 AM on December 24, 2009

Point out on national television how much money each recieved from the industry.

I don't remember where it originated, and I know it wasn't with him, but Robin Williams in his most recent HBO standup special (from early December) says that Congresscritters should have to campaign wearing jackets which look like NASCAR outfits, with emblems from all the lobbies and companies which give them money.

I'm thinking it's not a bad idea.
posted by hippybear at 8:57 AM on December 24, 2009 [9 favorites]

The Republicans didn't cave. Not one member of the Republican Party voted for cloture. Not one.

They could have kept filibustering

How? Their opposition voted for stopping debate, and did so with the required supermajority. They were not allowed to "keep filibustering" once the cloture motion passed; that's what the passage of a cloture motion is.

Am I missing something? They can vow to keep going until Mars crashes into the Sun, but if their opposition has sixty votes (which they did) and exercises those sixty votes (which they did), that vow is broken, and there's nothing they can do about it.
posted by Flunkie at 8:58 AM on December 24, 2009

Insurance company stocks have soared this week. I think that says everything about this healthcare "reform." You folk are so rudely, crudely screwed.
posted by five fresh fish at 8:59 AM on December 24, 2009 [1 favorite]

They could have kept filibustering, but they made it clear to Reid that they were quitting on Xmas Eve, and he announced it to the full Senate. Previously they had vowed to keep going until Valentine's Day and beyond.

If the Dems had done it right, they would have forced the Repubs to start that way back in August, would have never made ANY compromises to the rather excellent proposed bill they started out with, and the Repubs would still have caved on Xmas Eve and we'd have a public option on the way now.

The Dems let the minority party call nearly every shot in this whole debacle, and have let the country think that it was all their own idea. Bad bad bad. Why are they do bad at this game, when they had years to learn by experience when they were in the minority?
posted by hippybear at 9:00 AM on December 24, 2009

Insurance company stocks have soared this week. I think that says everything about this healthcare "reform.

I think it says everything about whether or not you've read the thread.
posted by Flunkie at 9:01 AM on December 24, 2009 [8 favorites]

Maybe the answer is to get more Massachusetts-y. When you have to reach a compromise between the people from NY and the people from AL you aren't going to get great policy.

Now that the federal government has raised the bar to where MA was 3 years ago, can MA create statewide single payer (with some duration of residency requirement to prevent nearby states from leeching)?

For all the Republican whining about inter-state competition being the answer, states as I understand it are free to agree to common standards for insurance regulation and increase their competition. Since the labor department will now be setting a baseline for what counts as "insurance" for the mandate some of the barrier to that should be reduced.
posted by a robot made out of meat at 9:01 AM on December 24, 2009

When you have to reach a compromise between the people from NY and the people from AL you aren't going to get great policy.

Thankfully, we didn't have to (and in fact we did not). We had to, and did, reach a compromise between the people from NY and the people from CT and NE. The people from AL were not interested in compromise, and their position - i.e. the status quo - lost.
posted by Flunkie at 9:05 AM on December 24, 2009 [1 favorite]

Strip Lieberman of his committee chair in response to his opposition.

I genuinely have no idea how you imagine that that would make it more likely for Lieberman to vote for cloture.

Lieberman doesn't care about the bill. Everything he does is for increased political power. He's flipped his position within weeks when doing so gave him more power, e.g. by opposing portions of this bill he previously supported. So if Reid had established that supporting the bill would give Lieberman the most political power (by maintaining committee chair), Lieberman would have supported it.

There's certainly room to disagree with how that might have played out. Nonetheless, that's what I would have liked to see Reid do.
posted by scottreynen at 9:08 AM on December 24, 2009 [2 favorites]

scottreynen, that's possibly true, although I personally believe that Lieberman is more interested in his petty grudge than in power. However, "threatening to remove Lieberman's chairmanship" is a different thing than "removing Lieberman's chairmanship", and the latter is what I was responding to when you suggested that it would increase the chances of getting sixty votes.
posted by Flunkie at 9:12 AM on December 24, 2009

Or 2006 and 2008, as we heard them say in 2005 and 2007. I'm a little tired of them having a majority without actually using it. It's high time the Democrats act like a majority because the chances that the solid red southern and western Senate seats ever turning blue are slim. You go tho the senate with the majority that you are given, not with the one you wished you had.

Republicans = Right
Democrats = Everyone else.

Assuming a democratic identity or common goals is foolishness. That's why they've never been able to use their "majority". It's more of an aggregated bunch of minorities.
posted by blue_beetle at 9:14 AM on December 24, 2009

But being uninsured is not free, no more than uninsured driving is free. Not having insurance only externalizes the costs. Providing health care to the uninsured costs us billions.

Yes, but if you don't want car insurance, you can ride the bus. Or walk. With health insurance you have no choice but to pay health insurance companies, who turn around and pay their CEOs millions of dollars.

It's certainly true that someone might end up footing the bill for your medical expenses if you're uninsured, but not until after you've gone bankrupt without insurance. Not to say that the current system is better but at least you have a choice. I really resent this "you're costing us all money by living" attitude that a lot of reformers had.

It's actually one of the reasons I supported Obama in the primaries. Mostly it was that I didn't want to vote for someone who voted for the Iraq war, but the mandate issue was something I agreed with him about.

That said, while I don't like this bill, it's better then the status quo for the vast majority of people: 1) People who have insurance through work won't notice anything 2) People who make less then 80k/year will receive some subsidy for insurance. So if they want insurance, will be get it and they won't have to pay nearly as much as they otherwise would. I don't think 8% of your salary (especially for people making that much money) is terrible.

---

But on the other, it's a complete sellout to the insurance companies. We've now got a private, regressive tax that takes money directly from the middle class and puts it in the pockets of the rich, all for providing what is, in most countries a government service. One which costs far, far less.

Also, HURF DURF FUCK LIEBERMAN. The Medicare buy-in was the perfect compromise, and he knew it. He just wants to get a good job with a lobbying firm, and he puts his own career above the American people.

His wife already works for a health insurance company. So he doesn't even need to wait to finish out his senate term.

I agree. and I think that they need to just let the Repubs filibuster and filibuster. Make them actually have to keep talking.

It doesn’t actually work that way because 1) They don't have to actually say anything, they can just sit there if they want and 2) They only need one guy in the room at a time, but you need all your guys there to break a filibuster. Since they have 40 members, they can take one 2 hour shift per every couple of days.

But I do think it should be gotten rid of.

---

Finally, this bill still leaves about 23 million people uninsured.

Ross K. Baker, a political scientist at Rutgers University and an expert on the history of the Senate, said that in earlier eras, senators would routinely cross party lines to vote in favor of major legislation on issues like civil rights and social welfare policy.

They would also cross party lines to vote against civil rights and social welfare. Let's not forget, a lot of the reason we had 'congenial' senate in the past was because there were so many segregationist democrats.
posted by delmoi at 9:16 AM on December 24, 2009

2) People who make less then 80k/year will receive some subsidy for insurance.

What's your source for that number? Ezra Klein says that the subsidies stop at 400% of the poverty line; 400% of the poverty line comes to $43,320 for an individual.
posted by enn at 9:20 AM on December 24, 2009

Blah, Blah, Blah.

You've managed cars and roads for every citizen but not health care. You've been to the moon, fed entire countries, employed millions. You don't have Universal health care because for the most part you hate each other, a martial people with no one left to fight.

So now your obscenely rich health companies (with your tax dollars) will cast their greedy eyes on my country, and others, continuing the destruction of our public health system.
posted by larry_darrell at 9:22 AM on December 24, 2009 [7 favorites]

*sigh* it's a start. I remain optimistic that this is but a first step in the process, we will at least have a framework in place to improve upon. As mentioned before medicare and social security where also big disappointments for progressives when first passed. And yeah, count me in the category of not hating the Democrats-in-general but in specific instances and, frankly the GOP in general. (to be honest though Lieberman is at the top of my shit list, I actually think he hates Obama for some reason or another and is constantly looking for ways to fuck him over. Lieberman may actually inspire me to make my first ever out of state $ contribution to whomever runs against him)

In a two party system, political parties should be coalition parties, they always should be some back and forth cross over voters on both sides, right now the GOP is acting like the Politburo of old, dissension is punished conformity is everything. That is what scares me the most, and incidentally there are a lot of progressives who really want the Democrats to be the exact same thing only you know... for good not evil {/}. I sympathize with those that are frustrated with the Dems, but frankly it IS just a handful who are this way... and that is normal, it is this near unprecedented automatic filibuster + party purity by the GOP that is the real and true problem. I have long resisted the idea of doing away with the filibuster as I see what the real benefits of it are, but in the current political climate even I think that it may be time to axe it until the GOP starts acting like adults again. (yeah it's been awhile)
posted by edgeways at 9:23 AM on December 24, 2009

Also, you wrote,

I don't think 8% of your salary (especially for people making that much money) is terrible.

Obviously people are going to differ on this, but keep in mind that a lot of people who fall into the bracket where they make more than 400% of the poverty line but don't have insurance are going to be contractors or freelancers getting 1099s; this means they already pay double the payroll tax that a W-2 employee pays (and most people pay more payroll tax than income tax), so their after-tax income is going to be significantly less than that of an insured W-2 employee making the same pre-tax income.
posted by enn at 9:24 AM on December 24, 2009

What's your source for that number? Ezra Klein says that the subsidies stop at 400% of the poverty line; 400% of the poverty line comes to $43,320 for an individual.

I remember seeing it somewhere. Maybe it was a different figure. $43k is probably closer to being right.
posted by delmoi at 9:25 AM on December 24, 2009

$80K might have been for a married couple. I don't know, I'm just guessing.
posted by Flunkie at 9:26 AM on December 24, 2009

What's your source for that number? Ezra Klein says that the subsidies stop at 400% of the poverty line; 400% of the poverty line comes to $43,320 for an individual.

Not to speak for the original poster, but it might come from a misreading of the following:

Both bills provide billions of dollars in subsidies once premiums exceed a certain percentage of annual incomes. The House bill is more generous than the Senate's if your income is on the lower end; the Senate is more generous for those on the higher end. The subsidies end at four times the poverty level—$88,200 for a family of four.

But the subsidies are determined based on what percentage of your annual income the insurance premiums cost. So anyone for whom a policy in absolute terms would exceed X percent of their annual income gets the subsidies. And in cases of financial hardship or religious objections, the mandate can be waived all together.
posted by saulgoodman at 9:26 AM on December 24, 2009

Well, the proof isn't in the recipe, it's in the pudding and the next fews years is the tasting.
posted by fuq at 9:29 AM on December 24, 2009

*** MISSION ACCOMPLISHED ***
posted by effwerd at 9:30 AM on December 24, 2009 [1 favorite]

*** MISSION ACCOMPLISHED ***

Just wait for Obama's singing statement.
posted by peeedro at 9:34 AM on December 24, 2009

Recall a bit of history: slavery became segregation became equal rights--not always perfect and not fast enough. But evolved in the right direction once it began.

No, it didn't. During reconstruction (1865-1887), newly emancipated former slaves were able to step into a power vacuum in the south. They controlled some state legislatures, were elected to congress. But white southerners resisted violently, in some cases literally attacking the new state governments, and the federal government lost the political willpower to fight for their civil rights. The election of 1876, perhaps the only election more controversial and devestating than the 2000 election, saw Tilden bow to Hayes, under the condition that Hayes abandon southern blacks and end reconstruction.

Cue literacy tests, poll taxes, and Jim Crow. It was eighty years in between the election of the second african american to the United States Senate, and the third. Who knows what might have happened if we had stayed and fought for reconstruction?

My point is this: Progress is not uniformly linear. Something that looks like a step forward can actually be a step back - just ask the women who may lose access to abortion because of this bill.

It may be that this bill is the most significant step forward we can possibly take at this time, or it may be a smokescreen that prevents us from making more and better progress in the future and causes us to settle.

No one can know that right now, and to pretend that we can - and that history can give us any guide to knowing - is a fairytale.
posted by shaun uh at 9:35 AM on December 24, 2009 [15 favorites]

Since you can't get blood from a stone, the money has to come from somewhere, such as the people who can afford it.

Or rents. Which is the same thing I guess.

This is not how government is supposed to opperate. This first step in government take over in your private lives whether you like it or not and no one seems to realize that.

My view is that laissez-faire free-market fundamentalism is very path-dependent and can work itself into serious inefficiencies, like say the Rockefeller and railroad trusts of 100+ years ago, and the recent mortgage orgy that went down.

Path-dependent, contingent -- these are terms used to describe evolution by natural selection. And that's where I get another term -- skyhooks -- to conceptualize government's optimal role in a modern mixed economy. Nobody wants government to run everything, what we want is government to make the free market work most effectively, something that really doesn't do that well on its own if history is any guide, and it is.

Government has great power to lift business situation out of one rut and into a better, more sustainable course of running. In the end the free market always wins, but run intelligently, government action does have the leverage to improve our way of life.

But we are a very stupid people and I don't have any great expectations any more that the 20th century position we've enjoyed will continue much longer into the 21st century.

The day our republic died was probably Dec 8, 2000.
posted by tad at 9:40 AM on December 24, 2009

Sure, Flunkie. This week appears to be an aberration, probably due to it being Christmas week and toward the historical year-end sell-off of stocks in the privileged arrange their taxes.
posted by five fresh fish at 9:45 AM on December 24, 2009 [1 favorite]

Cue literacy tests, poll taxes, and Jim Crow.

And sharecropping, in which the slaveholders got to "free" their slaves but still take the products of their labor.

Give me the private ownership of all the land, and will I move the earth? No; but I will do more. I will undertake to make slaves of all the human beings on the face of it. Not chattel slaves exactly, but slaves nevertheless. What an idiot I would be to make chattel slaves of them. I would have to find them salts and senna when they were sick, and whip them to work when they were lazy.-- Archimedes, attributed to Samuel Clemens

posted by tad at 9:46 AM on December 24, 2009 [3 favorites]

So if Reid had established that supporting the bill would give Lieberman the most political power (by maintaining committee chair), Lieberman would have supported it.


Lieberman seems to be getting his jollies by a) Sticking it to the Democrats and b) Establishing himself as the most far Right in the Democrat caucus. Or he may be an sociopath. At any rate, he may be stripped of his committee chair after the fact by being so hateful. He doesn't give a shit.
posted by angrycat at 10:04 AM on December 24, 2009

but if you insist, as fourcheesemac mentioned above, Health Insurance Stocks Decline on News of Senate Passage of Reform Bill; Have Underperformed Market Since Start of Week.

If you read Silver's website further, his story is a little more hazy:

"Therefore, the health insurer stocks have overperformed the market by slightly less than 2 percent."

Basically, once the public option was off the table, once threats to look into antitrust violations were removed, once insurance coverage was made mandatory, healthcare companies have been given pretty much everything they could hope for.
posted by Blazecock Pileon at 10:08 AM on December 24, 2009

It isn't perfect but does mean I can get insurance. So YAY for getting to live (a little longer)!
posted by Mick at 10:09 AM on December 24, 2009

A Cadillac health plan should not be determined on the basis of premium alone.

A $8,500 annual premium does not necessarily mean the plan is "Cadillac". I sell group health insurance and have seen more expensive plans simply because there are simply sick people in the group.
posted by yoyoceramic at 10:14 AM on December 24, 2009 [1 favorite]

It only took forty-five minutes for you to find something that could be interpreted as backing an opinion that's vaguely like the flatly incorrect opinion you espoused in your drive-by histrionic threadshit, fff? Kudos.
posted by Flunkie at 10:17 AM on December 24, 2009 [1 favorite]

This is a long way from what I had been hoping for (being of that peculiar type of centrist capitalist who believes that the corporate profit motive should be entirely decoupled from health and safety), but it's frankly better than I was expecting: which was nothing.

An end to pre-existing conditions and rescission in my opinion is a HUGE step in the right direction. I feel we will find that those words very rapidly disappear from daily language and the mere thought of reintroducing them will meet with Social Security-style outcry.
posted by chimaera at 10:26 AM on December 24, 2009 [2 favorites]

As I said in a thread earlier today - Americans are going to be seriously screwed by this bill due to the nature of our political process and the way in which our elected officials are held captive by the interests who fund them. Secret tip: the winner ain't gonna be you, average voter.

The senate chose to beat up on one industry (medical device suppliers - what the fuck is THAT about?) and curry favor with another (insurance companies), all the while tricking you into thinking this is a massively great thing. The senate didn't give you healthcare reform, it merely ensured the insurance companies get paid one way or another and plays classes off one another by sticking the wealthy with the bill. By the time this gets enacted into law you can be damned well assured that it won't just be "the other guy" paying the bill. Other states will demand exemptions, other industries will cry uncle or curry political favor.

Universal healthcare is a great concept and has worked well enough in other parts of the world. I simply do not trust our elected officials to craft, enact and honestly manage this program. There is simply way too much opportunity for graft and influence to make me feel jolly about this one little bit.

Too many cooks in this legislative kitchen resulting in too many far reaching tentacles around my neck. The beauty of this plan is that there will be too much time between passing this legislation and enacting it for anyone to notice, similar to a lobster slowly boiling in a pot.

If you were upset about the Patriot Act, No Child Left Behind, Medicare Part D or TARP, you should be more furious about this proposed legislation, regardless which side of the issue you are on. Just remember, those same assholes who brought you the aforementioned legislation are bringing you "healthcare reform."
posted by tgrundke at 10:28 AM on December 24, 2009 [1 favorite]

It only took forty-five minutes for you to find something that could be interpreted as backing an opinion that's vaguely like the flatly incorrect opinion you espoused in your drive-by histrionic threadshit, fff? Kudos.

I'm simply pointing out that Silver two analyses are contradictory, which makes me question his and your claims. Healthcare stocks are still undervalued and performing well on news of the watered-down bill, regardless, by most reports (cite):

The S&P Healthcare Index .GSPA rose 1.4 percent, while the Morgan Stanley Healthcare Payor stock index .HMO rose 3.6 percent. The S&P Managed Health Care index .GSPHMO rose 4.6 percent.

"All in all, relative to the last version of health reform issued by the Senate, things have turned out pretty well for the health insurance industry," said Carl McDonald, an analyst at Oppenheimer. "In particular, all versions of a government-run health plan have largely been eliminated." [emph. added]

By requiring everyone to get coverage, service providers win, regardless of the quality of care they provide. For example (cite):

Tenet is expected to benefit if healthcare reform passes and expands insurance coverage. Although such benefits wouldn't begin until 2014, "we believe that if the legislation passes (which looks very likely), it will help support hospital stock valuations over the next few years," Gurda wrote. [emph. added]

I think some kind of reform would be good, but let's be clear about who is benefitting from this. The public option was removed, everyone has to get coverage, and providers still maintain their control over local markets. Thus, a customer base has been provided for free and there's little pressure to contain costs. As-is, this bill is pretty much a win-win for the private healthcare industry.

Call it a bailout, call it corporate welfare, call it whatever, but it's not histrionics or threadshitting to suggest following the money.
posted by Blazecock Pileon at 10:38 AM on December 24, 2009

keep in mind that a lot of people who fall into the bracket where they make more than 400% of the poverty line but don't have insurance are going to be contractors or freelancers getting 1099s

In the health care bill, the poverty line is calculated based on your "Modified Gross Income". From the bill:

MODIFIED GROSS INCOME- The term `modified gross income' means gross income--

(i) decreased by the amount of any deduction allowable under paragraph (1), (3), (4), or (10) of section 62(a)
[...]

Section 62(a) refers to the IRS code, which allows you to take certain deductions when calculating your gross income. It looks like it's a subset of the deductions allowed when calculating your Adjusted Gross Income for tax purposes. Half of the self-employment tax is deductible under this scheme, meaning that self-employed people get to deduct that amount when determining whether their income is below some percentage of the federal poverty line.

The takeaway point: self-employed people are on a level playing field with everyone else when it comes to determining their subsidies for this health care bill.
posted by av123 at 10:38 AM on December 24, 2009 [1 favorite]

I am a progressive¹ who, as edgeways describes it, wants the democratic party to be run like the Politburo of old, where conformity is everything and dissension is punished. Though, since we have a system with more parties than one, I think the Irish Parliamentary Party is the better historical reference (or, really, any effective political party in any Westminster system ever).

Since the 1990s, the Republican party has been run more or less on Westminster lines — you do what the whip says on every significant issue, and if you don't, forget having any power in the party ever and kiss your funding for the next election goodbye. It only takes one party run along those lines to transform the house from a Washington-style weak parties system to a Westminster-style system. Once just one party has actually organized itself, the parties that continue acting like individual electoral representatives can make their own decisions and still receive support from their party are just playing pretend until they get sick of getting steamrollered by the party that understands that they're in a parliament.

This is not remotely a bad thing. Oh good lord, it's not a bad thing. If all parties realize they're in a parliament, voters get the privilege of actually voting for a party platform, rather than a personality. I don't know my representative — I mean, I know who he is, but I know precisely fuckall about him as a person, and really all I even want to know is that he consistently votes with the Democratic party. I am not voting for Jim McDermott, I am voting for that little D after his name and I make no bones about that. I have the luck to vote in a district and state where I can more or less trust my representative and senators to be the D after their names instead of individual, corruptible, and frequently breathtakingly stupid people. People who live in Nebraska don't have that privilege.

Basically, I believe the system is several orders of magnitude more transparent and more representative if debate and dissension happens while the party hashes out its platform, if people vote for that platform by voting for that party, and if representatives who get the bright idea to go against that platform, or get paid to go against that platform, get to go find or found their own party rather than pretending to be in one they vote against. If this makes me a horrible bad awful Soviet nogoodnik, then, well, I guess I'm a horrible bad awful Soviet nogoodnik.


1: Okay, social democrat, but I'll use the weasel term even though it's not accurate (progress is frequently a terrible idea).
posted by You Can't Tip a Buick at 10:46 AM on December 24, 2009 [9 favorites]

Blazecock, you're not the person I was speaking to with my sarcastic "it only took you forty-five minutes". It was addressed to "fff", i.e. five fresh fish, not you, and I didn't mean to say that you were threadshitting or histrionic. I meant to say that five fresh fish was threadshitting and histrionic.

In any case, as I said above, I'm not convinced that it's particularly wise to base opinions of whether or not a certain policy is good or bad based upon the behavior of the stock market in the first place.
posted by Flunkie at 10:58 AM on December 24, 2009

Sorry, I read "fff" as "ffs". Nevermind.
posted by Blazecock Pileon at 11:01 AM on December 24, 2009

I'm not convinced that it's particularly wise to base opinions of whether or not a certain policy is good or bad based upon the behavior of the stock market in the first place.

I'm not a professional investor, so anyone feel free to correct me on this, but now that the bill is more or less settled, there's much less uncertainty about the way forward, and once certainty has been introduced, people place their bets accordingly.

So far, investors seem to be gambling that the legislation we have on hand now will reap them large profits, presumably because of several long-term features designed into that legislation.

If you're going to have an opinion, one way or the other, on something that affects a large, private industry, it merits paying attention to self-interested people and where they think they can maximize their profits, based on the confidence in the information or certainty that is out there.
posted by Blazecock Pileon at 11:11 AM on December 24, 2009

I'm still waiting to hear about option B, the Republican Plan, or option C, the Progressive plan, since we have such a wide range of choices here. I think I have option D, the shit we're in, figured out.
posted by fourcheesemac at 11:31 AM on December 24, 2009 [1 favorite]

I really wonder what would've happened if this Barack Obama had been elected.
posted by mullingitover at 11:51 AM on December 24, 2009

Does anyone know if transgender-related expenses are covered in the bill? Earlier in the process, some were trying to get the old "anything related to SRS or transsexuality will not covered" clause into the bill. (This is hugely problematic because some doctors and clinics will consider any health problem a trans person has to be related to their being trans, and refuse to treat them for that reason.)
posted by jiawen at 11:53 AM on December 24, 2009

A poor person's life before the health insurance bailout: You get sick, you go to the emergency room because you can't afford to go to a PCP, you get diagnosed with advanced somethingoranother because you couldn't afford preventative care. You get whacked with $20,000 in bills. You start getting debt collector calls. You eventually declare bankruptcy.

A poor person's life after the health insurance bailout: You get sick. You go to the emergency room because your shitty insurance doesn't cover office visits. You get diagnosed with advanced somethingoranother because your insurance doesn't cover preventative care. The hospital bills your insurance company $15,000. Your deductible is $10,000. You fight for months to get your insurance company to cover the rest. They eventually drop you for "fraud" because you didn't disclose that your great uncle once removed once had a minor case of somethingoranother a few years ago. You start getting debt collector calls. You eventually declare bankruptcy.
posted by dirigibleman at 12:07 PM on December 24, 2009 [2 favorites]

Dirigibleman: Could you please learn something about the bill that was just passed before you decry it? Among other things, it will require all insurance companies to cover preventative care and office visits and will totally prohibit most of the bullshit insurance companies use to drop people when they actually need their insurance. It will not be perfect. It will not be ideal. God knows I'm a massive proponent of single-payer myself and I fucking hate the idea of mandating private insurance. But if you're going to criticize something that puts billions of dollars into providing health care for working-class Americans, please do us all the favor of opposing it on the basis of actual facts and not your nightmare-fantasy.
posted by Tomorrowful at 12:44 PM on December 24, 2009 [5 favorites]

A Cadillac health plan should not be determined on the basis of premium alone.

A $8,500 annual premium does not necessarily mean the plan is "Cadillac". I sell group health insurance and have seen more expensive plans simply because there are simply sick people in the group.

This is a good point and it's kind of surprising it's been overlooked. By people. The most expensive plans are not the best plans they are the plans that go to people with pre-existing conditions.

On the other hand, I think the bill changes the way insurance handles pre-existing conditions so it may not be any more expensive. Frankly I don't remember if that's still the case in the senate bill, but I think it is.

Dirigibleman: Could you please learn something about the bill that was just passed before you decry it? Among other things, it will require all insurance companies to cover preventative care and office visits and will totally prohibit most of the bullshit insurance companies use to drop people when they actually need their insurance.

If that were the bill, it would be pretty bad, but there are significant changes to the way insurance companies work. But the problem is all this stuff changes all the time and a bunch of important things got dropped in the Senate version. But supposedly rescission (where you get dropped from your insurance for "fraud") goes away.

But, problematically there are still deductibles and co-pays. And it's still in the interests of the insurance companies to screw you every way they can. They make a 3% profit. And while that sounds good it also means that if they can weasel out of just 1.5% of claim costs, they can increase their profits by 50%.

How for-profit insurance companies behave after this legislation is going to be a big determinant in its success. In the past, they have been pretty terrible. But, with this law in place, with people being forced to pay the political energy for reforms will still be there. I'd love to see, for example, insurance company salaries capped. No one would stand for government workers to make tens of millions a year, and so it's unlikely they'll be happy with healthcare CEOs making that kind of money from their tax dollars (either taxes to pay subsidies or mandatory fees)
posted by delmoi at 1:27 PM on December 24, 2009

I'm a little tired of them having a majority without actually using it.

They just passed health-care on a party-line vote. One Republican in both houses voted for it, and he was in the Bluest GOP district.

Don't mistake your optimal bill for "acting like they have the majority."
posted by Ironmouth at 2:11 PM on December 24, 2009

They want 8% more of my income in taxes? They can take it out of the 15% that goes directly to military contractors.
posted by Freen at 3:23 PM on December 24, 2009

Just wait for Obama's singing statement.

And a one, and a two, and a one-two-three-
posted by anigbrowl at 3:26 PM on December 24, 2009 [1 favorite]

Fringe conservatives sound a lot like fringe liberals did when the Patriot Act first passed. "Government takeover...invasion of privacy...Big Brother...this is a SLIPPERY SLOPE TOWARDS THE END OF ALL THINGS!" Now, as then, all I hear is "wah, wah, wah." The reality of the situation is that this is, in all likelyhood, not the first step towards a socialist totalitarian nightmare. This is a less-than-ideal first step towards a very good thing. It looks like in the end we will have a health care system very similar to that of Sweden. I am not happy that more was not done to address reigning in costs - as this is the core of our healthcare problem. Ironically, a single payer system makes for an ideal cost-control measure...but it seems that the stigma attached to a "public option" has yielded a bastardized bill that looks like it does very little to truly control administrative costs of health care payment or procedural costs of health care delivery. Hopefully this will be addressed in the future. The exchanges set up a good framework that could eventually house a public option.

Ultimately I'd rather hold a government accountable for healthcare rather than a private company with all the protections against retribution that companies have.
posted by jnnla at 6:32 PM on December 24, 2009

This is a less-than-ideal first step towards a very good thing.

Huh, you think the patriot act was a "less then ideal first step to a to a very good thing"? What could thing would that be?

Plus I don't know if you noticed, but by the end of the Bush administration we had a network of secret prisons around the world where people would be kidnapped off the streets (from other countries) and sent there with no trials or ad-hoc kafkaesque trials with ever shifting rules and secret evidence where you stay in jail anyway if you were declared not a terrorist in those trials. We had torture and we had prisoners tortured to death.

I'm a little unclear on how you could say that the predictions of doom and gloom were wrong here.

--

I'm certainly not saying that healthcare is at all like that, but it's pretty obvious that most of the dire predictions about the bush administration came true.
posted by delmoi at 4:03 AM on December 25, 2009 [3 favorites]

I find the optimism my fellow liberals express on the topic of this bill being the first small step that will be incrementally improved both amazing and unwarranted.

The filibuster is still in place.

Odds are extremely good that the nominal 60 vote Democratic majority in the Senate will vanish.

Which means that between 2010 and 2012 nothing is going to get passed, especially no improvements to the healthcare bill. We might see some cutting away at the few good things in the plan, in fact I'll wager we see a lot of that.

I'm also curious about what happens 10 years down the road. This bill provides for subsidies for 10 years, at a cost of around one trillion dollars. It is now 2019, a Republican is in office, and the Democrats have a slight majority in Congress. Do those subsidies get renewed? Over President R's veto? I think not.

Programs don't automatically grow. It can happen, but it is hardly a guaranteed process. And I don't see how this program can possibly grow given the forces (all Republicans everywhere, plus the bought off and conservative "Democrats) aligned against it.

I do, oddly, agree with the people who argued that this was our best shot, our only shot, at reform. And we failed miserably. From here on out there is no chance of improvement, and lots of chances for the very few and mostly worthless gains in this bill to be whittled away.

The first step will be for enforcement on the very few regulations imposed to be completely defunded. That's already happened in California, the insurance industry there is violating California law and continuing to exercise recission on people who get expensive medical problems. The enforcement end of the deal got defunded which makes all the regulations in the world pointless.

krinklyfig wrote Going to Iraq and Afghanistan cost us ~$1 trillion. Our priorities are not straight.

Actually, Iraq alone is estimated to have a total cost of around $3 trillion.
posted by sotonohito at 10:28 AM on December 25, 2009 [1 favorite]

More than anything else, I think the top priority of anyone who actually gives a damn about America has to be ending the filibuster.

If it takes 60 votes to get anything past the Republican obstructors in the Senate, then nothing worthwhile will ever get passed.

The filibuster must be eradicated.
posted by sotonohito at 10:30 AM on December 25, 2009 [1 favorite]

I think the top priority of anyone who actually gives a damn about America has to be ending the filibuster Republican Party.

ftfy.
posted by fourcheesemac at 11:06 AM on December 25, 2009 [1 favorite]

I do, oddly, agree with the people who argued that this was our best shot, our only shot, at reform. And we failed miserably. From here on out there is no chance of improvement, and lots of chances for the very few and mostly worthless gains in this bill to be whittled away.

The exact opposite is true. The part which was passed, massive subsidies for the poor and ending abusive industry practices, was the narrow D interest. The part which the current legislation does not touch is cost-containment, and that is a universal requirement.

You can't have one part of the economy grow 3x faster than the rest for very long. Costs are already a crisis, and they aren't going to get better on their own; pressure will continue to mount as premiums go up and up.
posted by a robot made out of meat at 11:37 AM on December 25, 2009

fourcheesemac Partisan as I am, I don't really see how the Republicans are to blame for our current mess. We know they're a bunch of reactionary twits who hate their fellow man and wish him ill, their vote against health care reform is a given.

What killed our chance of getting anything worth having was the Blue Dog Democrats, the conservative "Democrats". It wasn't all Joe Lieberman's fault, though of course he does deserve a lot of the blame. Ben Nelson and any of the other eight most right leaning Democrats could have, and would have, pulled the same stuff.

The problem, what killed us, is that thanks to the filibuster it takes 60 votes to pass anything. Or, rather, when it's a Democratic bill it takes 60 votes, naturally that doesn't apply to Republican bills, war bill, or anything that screws people over, those magically don't get filibustered ever under any circumstances.

The filibuster is what ruined the bill.

I won't even claim that the filibuster has never done anything good, I can't think, offhand, of anything good that has been accomplished via the filibuster, but even if it has ever done good, its bad outweighs the good tremendously. Not to mention the fact that philosophically it's a revolting anti-democratic slap in the face from an already anti-democratic body.

The filibuster must be eradicated.

a robot made out of meat write The part which the current legislation does not touch is cost-containment, and that is a universal requirement.

You can't have one part of the economy grow 3x faster than the rest for very long. Costs are already a crisis, and they aren't going to get better on their own; pressure will continue to mount as premiums go up and up.

Ideally, you'd be right. But I don't think it will work that way. The Republicans are the party of big business anyway, they'll never vote for anything that imposes cost containment. Right now, with a nominal 60 vote Democratic majority all it takes is one Democrat in the pocket of the insurance industry to kill cost containment. Even in the extremely unlikely event that in 2012 the Democrats retain that nominal supermajority, do you really think Lieberman (I-Atena), or Nelson ("D"-Mutual of Omaha) are going to let any cost containing measures through?

What will go is the "wasteful spending" on subsidies. The mandates will remain, no way a Republican will ever vote to get rid of something that transfers wealth from the poor to the rich, the subsidies will dry up, and cost containment will never happen as long as it takes 60 votes to pass anything significant out of the Senate.

This, right here, is the best we will ever see, it's all downhill from here.
posted by sotonohito at 11:57 AM on December 25, 2009

At this point, the filibuster is starting to look ridiculous. Does anyone have any examples of when it's (effectively) been used for good?

I think it's pretty wack too, but there was this time...
posted by the_bone at 12:13 PM on December 25, 2009

Joe Lieberman is in everyone's way.
posted by hippybear at 1:14 PM on December 25, 2009

fourcheesemac Partisan as I am, I don't really see how the Republicans are to blame for our current mess. We know they're a bunch of reactionary twits who hate their fellow man and wish him ill, their vote against health care reform is a given.

That makes no sense. If there were only 30 republicans, Lieberman and Nelson would be irrelevant.

The Republicans are the problem. They are uninterested in good faith governance or compromise.
posted by fourcheesemac at 4:28 PM on December 25, 2009

fourcheesemac Yeah, but if the Senate were actually a democratic body and didn't have the filibuster Lieberman and Nelson would be also be irrelevant.

Which do you think sounds more doable? Electing ten (ten!) more Democrats to the Senate, or changing a Senate rule? I'll agree that ending the filibuster is going to involve one hell of a fight, but I think it's going to be a much easier problem to solve than getting five states to flip Democratic.
posted by sotonohito at 5:32 PM on December 25, 2009

I'd like to see efforts in both directions, naturally.
posted by fourcheesemac at 6:35 PM on December 25, 2009

@ Delmoi - my comparison to the Patriot Act only goes as far as the whining about it. I still don't agree with you that the dire predictions of doom and gloom regarding the bush administration "came true." We are not living in a totalitarian futurescape the last time I checked.

Re. healthcare...I think its a good thing.
posted by jnnla at 8:39 PM on December 25, 2009

my comparison to the Patriot Act only goes as far as the whining about it.

Yes, people whined about it because it was bad. People "whined" about segregation, slavery, and all other types of bad policies that the U.S. government had instituted.

We are not living in a totalitarian futurescape the last time I checked.

Well, I don't think you would agree if you were an innocent gitmo detainee. And New Orleans got a little post-apocalyptic for a while.

Anyway, while there may have been some people who thought the country was going to end up a in a totalitarian state, most were simply concerned about the erosion of civil liberties. And erode they did, far more then most people expected.
posted by delmoi at 9:26 PM on December 25, 2009

I still don't agree with you that the dire predictions of doom and gloom regarding the bush administration "came true."

Wow.

I mean, it's certainly no "Judge Dredd" apocalyptic moonscape out your front door. But to not see that the dire predictions of unregulated surveillance of citizens came true, and to not see that the predictions that there were would be no WMDs of any sort came true, and to not see that the predictions about the need to use new, police-style tactics instead of old-school warfare came true, and to not see… oh gods there are so many failures to list…

I still don't agree with you that the dire predictions of doom and gloom regarding the bush administration "came true."

Again, wow.
posted by five fresh fish at 10:03 PM on December 25, 2009