HCR passes the house.
March 21, 2010 7:55 PM   Subscribe

House passes Healthcare reform. All that's left is voting on a reconciliation package for the senate to sign. But the house has passed the senate bill, which means this is basically a done deal.

Matt Yglesias recommended a song for Jim DeMint, who famously said that if HCR was stopped, it would be Obama's "Waterloo"
posted by delmoi (910 comments total) 56 users marked this as a favorite

 
it's a start
posted by angrycat at 7:57 PM on March 21, 2010 [29 favorites]


Yea
posted by Kale Slayer at 7:57 PM on March 21, 2010


I've watched school house rock about two dozen times and I'm still fuzzy ony why this thing keeps bouncing back and forth between the senate and the house. Please explain.
posted by pwally at 7:57 PM on March 21, 2010 [7 favorites]


Yes. A corner has been turned.
posted by Artful Codger at 7:58 PM on March 21, 2010 [3 favorites]


Conservative journalist David Frum provides his perspective on who are the victors and who are the defeated in the Health Care "Waterloo."
posted by crunchland at 7:59 PM on March 21, 2010 [35 favorites]


Watching this, I wish someone would remind people that abortion is currently a legal medical procedure. If you would like to go after making abortion illegal, do so, but not at the expense of health care reform.
posted by thorny at 7:59 PM on March 21, 2010 [41 favorites]


Dear American Women,

I want to make sure you know that I place a high value on your reproductive rights.

They made an excellent bargaining chip.

Thanks,
President Barack Obama

posted by Joe Beese at 8:00 PM on March 21, 2010 [71 favorites]


I didn't know C-Span was airing Jerry Springer reruns!
posted by hellojed at 8:01 PM on March 21, 2010


Because I'm a glutton for punishment, I immediately went to the Drudge Report to see what the spin will be.

The headline (in 72-pt underlined bold red all-caps): A DATE WHICH WILL LIVE IN INFIRMARY

The link: A story which reads, in part, Summoned to success by President Barack Obama, the Democratic-controlled Congress approved historic legislation Sunday night extending health care to tens of millions of uninsured Americans and cracking down on insurance company abuses, a climactic chapter in the century-long quest for near universal coverage.

So, please, all me to be the first to say to all of our fellow Americans on the other side of the aisle:

IS THAT ALL YOU FUCKERS GOT?
posted by shakespeherian at 8:02 PM on March 21, 2010 [17 favorites]


Watch for a huge rise in the stock prices of health insurance companies over the next few days, and a rise in medical bankruptcies over the years after this stuff starts kicking in.
posted by Pope Guilty at 8:02 PM on March 21, 2010 [7 favorites]


The National Organization for Women is incensed that President Barack Obama agreed today to issue an executive order designed to appease a handful of anti-choice Democrats who have held up health care reform in an effort to restrict women’s access to abortion. ...

Contrary to language in the draft of the executive order and repeated assertions in the news, the Hyde Amendment is not settled law — it is an illegitimate tack-on to an annual must-pass appropriations bill. NOW has a longstanding objection to Hyde and, in fact, was looking forward to working with this president and Congress to bring an end to these restrictions. We see now that we have our work cut out for us far beyond what we ever anticipated.

posted by Joe Beese at 8:02 PM on March 21, 2010 [2 favorites]


all the fun is going down here
posted by localhuman at 8:03 PM on March 21, 2010


Now that it's passed, can someone provide a succinct list of what will change?

In all the political and procedural fighting, I still don't have a clear idea. Thanks.
posted by letitrain at 8:03 PM on March 21, 2010 [6 favorites]


I've watched school house rock about two dozen times and I'm still fuzzy ony why this thing keeps bouncing back and forth between the senate and the house. Please explain.

The school house rock version was the house would pass a bill, then the senate would pass the same bill. But in reality the house and senate both work on their bills at the same time. In this case, they ended up different.

So the two bills have to be synchronized, and they do this in a confrence cmmittee, and then the house and senate both vote on the bill. I always thought that that what was 'reconciliation' was, but apparently reconciliation is something else entirely.

In this instance, the legislative path was even more convoluted. Basically the house passed their version, then the senate passed theirs. They were different. But if they did the regular confrence committee thing, the new version of the bill could be filibustered, but because the democrats now only had 59 votes, rather then 60, they couldn't overcome it.

So, what they decided to do was have the house pass the senate version as is but then pass what they called a "sidecar" bill that would modify the bill they just passed, just like you can modify any bill that's ever been passed.

And the idea is, all of the items in the "sidecar" would qualify for reconciliation because everything in the "sidecar" would be directly related to the government's budget.
posted by delmoi at 8:03 PM on March 21, 2010 [16 favorites]


Really, Joe Beese? That seems rather simplistic.
posted by Solon and Thanks at 8:03 PM on March 21, 2010 [3 favorites]


Oh, come on, Joe Beese. Obama's agreement with Stupak basically boils down to taking imaginary action to address Stupak's made-up problems with the HCR bill.
posted by mightygodking at 8:03 PM on March 21, 2010 [27 favorites]


I feel like thread isn't the best.
posted by kylej at 8:03 PM on March 21, 2010


Handing the insurance industry 30 million paying customers, no public option, no price controls, and it'll be a while before it goes into effect to give the industry time to figure out how to benefit the most from it and jack up prices...

This is considered "socialism/communism" in the US.

lol
posted by hamida2242 at 8:04 PM on March 21, 2010 [123 favorites]


Congratulations USA on doing the impossible -- passing a Health Care Bill that even Nixon could get behind and somehow making it into a nail-biter.

That said, those Tea Partiers seemed pretty steeped about all this.

Now that this is all done, a nice relaxing cup o'Chamomile is just what the doctor ordered.

And by ordered I mean officially mandated by the new State-sanctioned Death Panel.
posted by mazola at 8:04 PM on March 21, 2010 [15 favorites]


Of course, Obama used women's rights as a bargaining chip, shutting down various challenges to the Hyde Amendment by executive order in order to buy a few more votes.
posted by dejah420 at 8:05 PM on March 21, 2010 [1 favorite]


At least the whole thing is a baby step in the right direction. Right now it's a big giveaway to the insurance companies, but I can't help but think we'll see further improvement in regulation and hopefully some real cost controls once budgetary concerns force the issue.

It's not a bad bill, it does a lot of good for people individually, but it fails to address the underlying cost inflation.
posted by wierdo at 8:05 PM on March 21, 2010 [1 favorite]


Still no universal health-care, though, right?

Carry on.
posted by paisley henosis at 8:06 PM on March 21, 2010 [11 favorites]



Now that it's passed, can someone provide a succinct list of what will change?


-The pools full of money that insurance CEO's swim in are going to get a little bit bigger
-Democrats going to get owned for the next few elections
-
posted by hamida2242 at 8:06 PM on March 21, 2010 [9 favorites]


Congratulations USA on doing the impossible -- passing a Health Care Bill that even Nixon could get behind

Nixon wanted UHC. This is nothing even vaguely approaching UHC.
posted by Pope Guilty at 8:06 PM on March 21, 2010 [21 favorites]


30 million new customers plus billions in federal subsidies...this is a bailout for the insurance industry which has been losing customers in the face of ballooning costs.
posted by ennui.bz at 8:07 PM on March 21, 2010 [10 favorites]


The vote breakdown.
posted by nbergus at 8:08 PM on March 21, 2010 [5 favorites]


.
posted by blaneyphoto at 8:09 PM on March 21, 2010 [1 favorite]


What the hell is stupack doing? People are tweeting that he's revolting.
posted by angrycat at 8:09 PM on March 21, 2010


The senators who began giving speeches opposing abortion as violating the sancitity of human life are the biggest of hypocrites. How were these people able to vote to send our soldiers to die in Iraq, in a war that was based on lies and fabrications?
posted by reenum at 8:09 PM on March 21, 2010 [8 favorites]


Now that it's passed, can someone provide a succinct list of what will change?

Not succinct, but here's a recent Reuters article I saw linked, via popurls: -"FACTBOX-US healthcare bill would provide immediate benefits" - http://www.reuters.com/article/idUSN1914020220100319
posted by cashman at 8:10 PM on March 21, 2010 [9 favorites]


Where do I apply to be on one of them Death Panels? Sounds like a cool gig!
posted by HTuttle at 8:10 PM on March 21, 2010 [3 favorites]


The executive order supposedly has no effect, but I agree the handling of abortion in this bill was total B.S. And yeah, this doesn't cover everyone, unfortunately.

Still, it's probably a step in the right direction, and now that the step has been taken and health insurance is mandatory, people will be much more open to government "interference" in the insurance market, IMO. If people have problems with their plans, they'll want the government to fix them, rather then simply wanting the government to exit the industry, leaving them uninsured.

I don't like mandates without a public option, but this will make the public option much easier to implement in the future.

It's not a bad bill, it does a lot of good for people individually, but it fails to address the underlying cost inflation.

There are a lot of things in there to tackle cost inflation, I believe.
posted by delmoi at 8:10 PM on March 21, 2010 [7 favorites]


but it fails to address the underlying cost inflation.

Right, which was the big selling point in the first place. Our health care expenses are going to go UP from this, not down, but everyone was screaming that we needed this in order to contain costs.

It was bullshit. There was never a time when it wasn't bullshit.
posted by Malor at 8:11 PM on March 21, 2010 [8 favorites]


Conservative journalist David Frum provides his perspective on who are the victors and who are the defeated in the Health Care "Waterloo."
No illusions please: This bill will not be repealed. Even if Republicans scored a 1994 style landslide in November, how many votes could we muster to re-open the “doughnut hole” and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25 year olds from their parents’ insurance coverage? And even if the votes were there – would President Obama sign such a repeal?
Yup.

Also, welcome back, crunchland.
posted by grouse at 8:12 PM on March 21, 2010 [2 favorites]


Now that it's passed, can someone provide a succinct list of what will change?

NY Times article has a run down. From a quick read over, here's what it lists:

It would require everyone to have insurance, add a lot of people to medicaid roles, subsidize insurance for low/middle-income, let children stay on their parents insurance until the age of 26, make it so insurers can't drop people w/ illnesses or deny children who are ill (not sure how this relates to "pre-existing conditons"), require businesses to offer insurance, give tax credit to small businesses to help pay for insurance.
posted by Solon and Thanks at 8:12 PM on March 21, 2010 [3 favorites]


ennui.bz: "30 million new customers plus billions in federal subsidies...this is a bailout for the insurance industry which has been losing customers in the face of ballooning costs."

Obama has proven to be the most lucrative investment they've ever made.
posted by Joe Beese at 8:12 PM on March 21, 2010 [7 favorites]


EAT SHIT AND DIE, TEA PARTY.
posted by SansPoint at 8:12 PM on March 21, 2010 [24 favorites]


I've watched school house rock about two dozen times and I'm still fuzzy on why this thing keeps bouncing back and forth between the senate and the house. Please explain.

I'm a bit fuzzy, too, but it looks like a full explanation would require a super-duper extended director's edition-dancefloor DJ megamix version of the School House Rock song. Until then, here's a high school student creation that explains the process in a bit more detail, but not too much.

Or, what delmoi said.
posted by filthy light thief at 8:12 PM on March 21, 2010 [4 favorites]


Malor, costs are going to go up, but not as much.
That was the deal all along. Nobody promised fixed-rate insurance for eternity.
posted by angrycat at 8:13 PM on March 21, 2010


Oh, come on, Joe Beese. Obama's agreement with Stupak basically boils down to taking imaginary action to address Stupak's made-up problems with the HCR bill.

It's one thing to piss on my leg, it's another to issue an executive order telling the world how much I should like it.

Women's rights activists are infuriated at the bill itself. The Nelson abortion language is outrageous on its own terms and restricts abortion rights much further than the status quo. Apparently, forcing women to write a separate check and use phony numbers to cross-subsidize pro-life plans wasn't enough. Singling out one procedure and using legislative defined bad math to control the lives of low-income women didn't mollify Stupak enough. So Obama went out of his way to make him happy - even though pro-choice advocates got nothing from the bill.

Yeah, I'd say there's a lot to be angry about here. Imagine if African-Americans had to pay an artificially high amount to get coverage for Sickle Cell Anemia using a separate check because the Klan hated the idea of Black people being treated as humans. And imagine if that wasn't enough to placate the worst of the bunch so Obama decided to issue an executive order talking about how great the status quo of racism is.

I'm glad people are happy. I wish I could share their joy.
posted by allen.spaulding at 8:13 PM on March 21, 2010 [33 favorites]


What the hell is stupack doing? People are tweeting that he's revolting.

Maybe anti-HCR people claiming he's revolting from the Pro-life line?
teacherken : CNN reporting that some Republican Congressmen shouted at Bart Stupak "baby-killer" #hcr

...
StopTheTakeover: Bart Stupak is a SPINELESS HYPOCRITE! #TCOT #IAMTHEMOB
Etc. Stupak ended up voting for the bill.
posted by delmoi at 8:14 PM on March 21, 2010


You guys are a bunch of debbie downers.

Seriously I am so thrilled that this happened. This is the biggest bill of my lifetime. It may not do all that I want it to, but it's certainly an awesomely fantastic step in the right direction. Pony requests will start making their way in soon enough...

I am beaming. I don't care if the shit's still kinda fucked up. It will probably always be. But you guys! We got healthcare!

Take that you teabaggers!!! (Written while tipsy)
posted by ohyouknow at 8:14 PM on March 21, 2010 [51 favorites]


I'm going to be completely honest here.

The health care bill has several serious problems. So I'm kind of two minds about that. But it's needed regardless.

OTOH, take that Teabaggers! Right up your collective asses! Fuck you so very much!

Okay, if this is too divisive, mods can remove it. But I feel better having typed it.

Sort of my own personal mental health care program.

::sigh, it wasn't a NY fiasco:: ::double sigh::
posted by Splunge at 8:14 PM on March 21, 2010 [8 favorites]


They're taxing our tanning salons!? Noooo!!
posted by MaritaCov at 8:15 PM on March 21, 2010 [1 favorite]


I just heard a caller to C-SPAN (from my city) who is against this bill but admitted that he doesn't have insurance himself because "I consider myself a healthy person".
posted by octothorpe at 8:15 PM on March 21, 2010 [9 favorites]


Gonna open an abortion clinic and get in on the tax-funded bonanza!
posted by hamida2242 at 8:15 PM on March 21, 2010 [1 favorite]


*A 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.

In your face Boehner!
posted by edverb at 8:16 PM on March 21, 2010 [61 favorites]


Women's rights activists are infuriated at the bill itself.

Actually it's not like we, or women in general, are a monolithic group. Personally, I'm not about to denounce a bill that helps a lot of people even if it has bullshit backwards policies about my body and my rights. If that's what it took to get a bill passed, I'll take it and work towards correcting the messed up parts rather than take nothing at all and see people continue to die when their health insurance drops them for getting sick.
posted by Solon and Thanks at 8:17 PM on March 21, 2010 [128 favorites]


How were these people able to vote to send our soldiers to die in Iraq, in a war that was based on lies and fabrications?

Cognitive dissonance/unprincipled pandering?

...From a Republican???
posted by hamida2242 at 8:17 PM on March 21, 2010 [3 favorites]


Not succinct, but here's a recent Reuters article I saw linked, via popurls: -"FACTBOX-US healthcare bill would provide immediate benefits" - http://www.reuters.com/article/idUSN1914020220100319
*Insurance companies will be barred from dropping people from coverage when they get sick. Lifetime coverage limits will be eliminated and annual limits are to be restricted.

*Insurers will be barred from excluding children for coverage because of pre-existing conditions.

*Young adults will be able to stay on their parents' health plans until the age of 26. Many health plans currently drop dependents from coverage when they turn 19 or finish college.

*Uninsured adults with a pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014.

*A temporary reinsurance program is created to help companies maintain health coverage for early retirees between the ages of 55 and 64. This also expires in 2014.

*Medicare drug beneficiaries who fall into the "doughnut hole" coverage gap will get a $250 rebate. The bill eventually closes that gap which currently begins after $2,700 is spent on drugs. Coverage starts again after $6,154 is spent.

*A tax credit becomes available for some small businesses to help provide coverage for workers.

*A 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.

WHAT HAPPENS IN 2011

*Medicare provides 10 percent bonus payments to primary care physicians and general surgeons.

*Medicare beneficiaries will be able to get a free annual wellness visit and personalized prevention plan service. New health plans will be required to cover preventive services with little or no cost to patients.

*A new program under the Medicaid plan for the poor goes into effect in October that allows states to offer home and community based care for the disabled that might otherwise require institutional care.

*Payments to insurers offering Medicare Advantage services are frozen at 2010 levels. These payments are to be gradually reduced to bring them more in line with traditional Medicare.

*Employers are required to disclose the value of health benefits on employees' W-2 tax forms.

*An annual fee is imposed on pharmaceutical companies according to market share. The fee does not apply to companies with sales of $5 million or less.

WHAT HAPPENS IN 2012

*Physician payment reforms are implemented in Medicare to enhance primary care services and encourage doctors to form "accountable care organizations" to improve quality and efficiency of care.

*An incentive program is established in Medicare for acute care hospitals to improve quality outcomes.

*The Centers for Medicare and Medicaid Services, which oversees the government programs, begin tracking hospital readmission rates and puts in place financial incentives to reduce preventable readmissions.

WHAT HAPPENS IN 2013

*A national pilot program is established for Medicare on payment bundling to encourage doctors, hospitals and other care providers to better coordinate patient care.

*The threshold for claiming medical expenses on itemized tax returns is raised to 10 percent from 7.5 percent of income. The threshold remains at 7.5 percent for the elderly through 2016.

*The Medicare payroll tax is raised to 2.35 percent from 1.45 percent for individuals earning more than $200,000 and married couples with incomes over $250,000. The tax is imposed on some investment income for that income group.

*A 2.9 percent excise tax in imposed on the sale of medical devices. Anything generally purchased at the retail level by the public is excluded from the tax.

WHAT HAPPENS IN 2014

*State health insurance exchanges for small businesses and individuals open.

*Most people will be required to obtain health insurance coverage or pay a fine if they don't. Healthcare tax credits become available to help people with incomes up to 400 percent of poverty purchase coverage on the exchange.

*Health plans no longer can exclude people from coverage due to pre-existing conditions.

*Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidized insurance on the exchange. The first 30 employees aren't counted for the fine.

*Health insurance companies begin paying a fee based on their market share.

WHAT HAPPENS IN 2015

*Medicare creates a physician payment program aimed at rewarding quality of care rather than volume of services.

WHAT HAPPENS IN 2018

*An excise tax on high cost employer-provided plans is imposed. The first $27,500 of a family plan and $10,200 for individual coverage is exempt from the tax. Higher levels are set for plans covering retirees and people in high risk professions. (Reporting by Donna Smith; Editing by David Alexander and Eric Beech)

posted by ennui.bz at 8:17 PM on March 21, 2010 [191 favorites]


Both "Babykiller" and "Bart Stupak" are trending topics on twitter.
posted by angrycat at 8:17 PM on March 21, 2010


No more cheap insurance for those who stay healthy. Every policy has to do so much that those days are now gone.

Expect to pay more unless you're already a corporate slave sucking the secure mammary of big biz.
posted by HTuttle at 8:18 PM on March 21, 2010 [2 favorites]


It may not do all that I want it to, but it's certainly an awesomely fantastic step in the right direction.

Exactly. The most important thing about is that not only is it a step in the right direction, but that step is on a ratchet, as Frum pointed out. There are lots of things this bill does which would be as thinkable to roll back in three years as Medicare would be today.
posted by grouse at 8:18 PM on March 21, 2010 [2 favorites]


*A 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.

BRB, buying a spray tan parlor...

Back, too late, I live in Brooklyn, NY

Damn.
posted by Splunge at 8:18 PM on March 21, 2010 [2 favorites]


But as we stand here on the precipice of watching the Democrats deal the biggest blow to abortion rights since the passage of the Hyde amendment, let’s just remember what the language in the Senate bill actually does:

* Allows states to opt out of allowing plans to cover abortion in the insurance exchanges, a clear violation of Roe v. Wade. Since some state medicaid programs cover abortion as long as it is paid for with state money, the Hyde amendment (current law) obviously does allow insurance to cover abortion as long as it is paid through a separate non-federal funds.

* Prohibits insurance companies by law from taking into account cost savings when estimating the costs of abortion care, which raises premiums, thus limiting access.

* It includes “conscience clause” language that protects both individuals and entities that refuse to provide, pay for, provide coverage for, or refer for abortion.

posted by Joe Beese at 8:19 PM on March 21, 2010 [3 favorites]


Expect to pay more unless you're already a corporate slave sucking the secure mammary of big biz.

Uh... what? Everyone always expected to pay more! This is about providing coverage for poor people, not making $$.
posted by Solon and Thanks at 8:19 PM on March 21, 2010 [8 favorites]


I'm not about to denounce a bill that helps a lot of people

Yeah, it's going to be great when poor people have to buy insurance plans with huge deductibles that they can't afford to actually use.

YES WE CAN! YES WE CAN! YES WE CAN!
posted by Pope Guilty at 8:21 PM on March 21, 2010 [13 favorites]


I think this bill is a big love note from the Democrats to big business and Wall Street. The note says:

"Who loves you, me or Orly Taitz."
posted by ennui.bz at 8:21 PM on March 21, 2010 [2 favorites]


Now dems asking for a recorded vote. RUBBING IT IN.
posted by Ironmouth at 8:22 PM on March 21, 2010 [2 favorites]


But you guys! We got healthcare!

What we got is health insurance which, as many people know, is not the same as getting health care.
posted by stefanie at 8:22 PM on March 21, 2010 [35 favorites]


Does this mean SAFRA will also become law? That's pretty major, isn't it?

As a Medicare recipient, there are some things coming down the pike that will probably make life more difficult for me. I've already seen my first Medicare Advantage plan canceled after some cuts and had to find a new one (one of the very few in my area serving people like me). These new big cuts will probably spell the end of the plan. For some people they'll lose a lot of money, for me it's just mostly going to be a lot of hassle. I'm more worried about the big cut to home health care services, which I also use. But my experience with disability has been nothing but hassle, pain, annoyance, and disappointment so I guess if uninsured people get something out of it then whatever, okay.

I've done a lot of searching recently to find out exactly what's going on, but so many of the newspaper articles have been partisan politics either trying to sell the bill or undercut the bill. Hopefully now there will be more useful information.
posted by Danila at 8:23 PM on March 21, 2010 [4 favorites]


Yeah, it's going to be great when poor people have to buy insurance plans with huge deductibles that they can't afford to actually use.

Can you tell us what those deductibles are going to be? Do you have facts demonstrating that the poor will have to buy insurance plans they can't afford to use? You have advanced the proposition, now support it.
posted by Ironmouth at 8:23 PM on March 21, 2010 [26 favorites]


I have a lot of problems with this bill and honestly it's so bad at one point I didn't even really want it to pass and I am very pro universal healthcare.

That being said I am very happy it has passed. Despite all it's failings, it paves the way for real healthcare reform in the future. I have a feeling that once Americans get a taste of universal healthcare, they will never turn back just like Europe, Australia and Canada to name a few.
posted by whoaali at 8:23 PM on March 21, 2010 [1 favorite]


Yeah, it's going to be great when poor people have to buy insurance plans with huge deductibles that they can't afford to actually use.

? The plan is to add 16 million people to Medicaid and subsidize low- and middle-income persons.

I don't think this is a fantastic bill, but I do think it helps a lot of people. (... I'm sure anyone with a preexisting condition would agree with me.)
posted by Solon and Thanks at 8:24 PM on March 21, 2010 [1 favorite]


Uh... what? Everyone always expected to pay more! This is about providing coverage for poor people, not making $$.

Actually, people who already have healthcare will see their premiums go down as more healthy-but-currently-uninsured people are forced to sign up.
posted by delmoi at 8:24 PM on March 21, 2010 [11 favorites]


ennui.bz: *Insurance companies will be barred from dropping people from coverage when they get sick. Lifetime coverage limits will be eliminated and annual limits are to be restricted.

So, if I was already in the process of (finally) getting health insurance, but was expecting to have to wait months to be able to start using it, to avoid getting dropped, than this means that I wouldn't don't have to wait, and can dive right in to spending their money, and they can't drop me? Effective when? Now, like now now?

It's still a pile of stink compared to universal health care, but if I'm reading that right, it sounds pretty cool for me, personally.
posted by paisley henosis at 8:25 PM on March 21, 2010


Uh... what? Everyone always expected to pay more! This is about providing coverage for poor people, not making $$.

You'd think after Nixon and Reagan and Bush, the Democrats would realize that providing for the poor translates as "taking my money" and giving it to 'welfare queens' or illegal immigrants.

The way you get a social welfare program is to provide benefits to everybody. In the end, "big government" benefits the middle class the most, regardless of the political framing.

But that's why this is essentially the health reform bill signed by Mitt Fucking Romney, in the running to be President Hoover II.
posted by ennui.bz at 8:26 PM on March 21, 2010 [2 favorites]


Does anyone have a "cheat sheet" for the unemployed and self-employed that will help us deal with the changes over the coming months/years? Or should I just be super-happy and tell the tea parties to STFU on Twitter?
posted by RobotVoodooPower at 8:26 PM on March 21, 2010 [1 favorite]


Joe Beese: "But as we stand here on the precipice of watching the Democrats deal the biggest blow to abortion rights since the passage of the Hyde amendment, let’s just remember what the language in the Senate bill actually does:

* Allows states to opt out of allowing plans to cover abortion in the insurance exchanges, a clear violation of Roe v. Wade. Since some state medicaid programs cover abortion as long as it is paid for with state money, the Hyde amendment (current law) obviously does allow insurance to cover abortion as long as it is paid through a separate non-federal funds.

* Prohibits insurance companies by law from taking into account cost savings when estimating the costs of abortion care, which raises premiums, thus limiting access.

* It includes “conscience clause” language that protects both individuals and entities that refuse to provide, pay for, provide coverage for, or refer for abortion.
"

Joe? Where did that come from? Just curious. Not the website you quoted, that's clear. Where did that clause in the package come from? Who put that in there? Was that original to the bill? Or was that a concession given to the right?

I'm serious here.

I'd like to know.
posted by Splunge at 8:26 PM on March 21, 2010 [1 favorite]


*Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidized insurance on the exchange. The first 30 employees aren't counted for the fine.

Does anybody have information on how this will play out for, say, Wal-Mart? Is this all employees, or just FTEs?
posted by one_bean at 8:26 PM on March 21, 2010


When the people on the far left and the far right are both furious, I assume something good has just happened. So, yay Obama.
posted by Bookhouse at 8:27 PM on March 21, 2010 [32 favorites]


Via Krugman
Rove: “This thing is paid for with Bernie-Madoff-style accounting. … It’s a gigantic disaster.”

Plouffe: “Karl and the Republicans would be familiar with that.”

Rove: “You will bankrupt the country if this bill passes. … For God’s sake, will you stop throwing around epitaphs [sic] and deal with the facts for once, David? … We will fight the election on this,. and the Democrats will have significant losses in the House and Senate as a result of this bill.”

Plouffe: “If Karl and a lot of Republicans want to call the election already, they ought to break out that ‘Mission Accomplished’ banner.”

Rove: “That’s cheesy, David. … You should not denigrate the mission of the USS Abraham Lincoln.”
Heh.
posted by delmoi at 8:27 PM on March 21, 2010 [36 favorites]


I remember when I first learned--as a child--that people who got sick sometimes couldn't see a doctor because they couldn't afford it. And from then on, my childish confusion and sadness grew into a passion for an issue, but then later into an awful cynicism. A cynicism that caused me to regret Obama's nomination and doubt his willingness to do anything on such a miserable issue.

No this bill isn't perfect. No Obama didn't play the game perfectly. But none of that matters to me at the moment. This bill is better than any that have made it this far, and I'll happily give credit for achieving such a feat in such a broken system. To everybody who had a hand in this--from caucusers and volunteers to Pelosi and Obama, cheers.

Today is a happy day for a lot of people.
posted by dsword at 8:28 PM on March 21, 2010 [36 favorites]


From the reuters link.... "What happens in 2014: *Health plans no longer can exclude people from coverage due to pre-existing conditions."

Um, what? Why wasn't that one of the immediate things?
posted by odinsdream at 8:28 PM on March 21, 2010 [7 favorites]


psst. Come latelies
posted by The Whelk at 8:28 PM on March 21, 2010


The senators who began giving speeches opposing abortion as violating the sancitity of human life are the biggest of hypocrites.

I disagree. The ones who cited the cost as a problem are bigger, since not one of them hesitated to vote for roughly three times the cost of this to fund the invasion of Iraq. Of course, that was "off the budget," so I guess it didn't really count. Now that the Republicans are out of power, they're suddenly fiscally conservative again.
posted by Jimmy Havok at 8:28 PM on March 21, 2010 [2 favorites]


Mr. Speaker, I request unanimous consent to revise and extend my remarks in opposition to this flawed fpp!
posted by _aa_ at 8:29 PM on March 21, 2010 [3 favorites]


First!
posted by zerobyproxy at 8:29 PM on March 21, 2010


Way to go, USA.

One thing I never understand: why are people so hung up on whether this will save money? What's wrong with basic social programs - including those designed to ensure that if you lose your job and get sick you don't die, go bankrupt, or go bankrupt then die - costing the government money? Do people imagine that they were raised in an Hobbesian state of nature, and that what they have is theirs by virtue of their own endeavours and nothing else? Why shouldn't they owe something to their fellow citizens whose own work makes their society possible? I mean, sure, in the context of the American medical system, which costs more and produces worse health outcomes than any other comparable rich country, it shouldn't be too hard to find some savings, but if it costs more to ensure that the number of people equivalent to the population of Canada don't have to face a painful, expensive death if the vicissitudes of nature frown upon them, what the fuck is wrong with that? Aren't these the people you're willing to spend hundreds of billions in military spending every year to protect? What's wrong with spending a few billion more to save them from, say, cancer, which last I checked killed a lot more Americans and directly cost the U.S. a lot more money than did terrorism, or whatever else?

Anyway, as I say, way to go. Way too late, far more complicated than it needed to be (can you say, public option? As in, available to be freely chosen, as in, competition, as in greater efficiency, as in, all those things you claim to like?) - but done nonetheless. Thirty-two million people whose lives will be demonstrably, massively better off. An entitlement program that will, hopefully, grow and grow until all Americans realize that Jesus never said anything about low taxes getting you into heaven, though he might have had a kind word or two for those who helped their fellow man.
posted by Dasein at 8:29 PM on March 21, 2010 [179 favorites]


Can you tell us what those deductibles are going to be?

If they're anything like the cheaper plans available now- and there's nothing preventing that- the answer is "ruinous".

Do you have facts demonstrating that the poor will have to buy insurance plans they can't afford to use?

Everyone has to buy insurance, and those who can't afford good plans are going to get cheap plans, and cheap insurance is only better than no insurance if you're racking up enough costs to get over the ridiculous deductibles and co-pays.


Insurance companies will be barred from dropping people from coverage when they get sick.

California's anti-rescission law hasn't stopped insurance companies from dumping unprofitable customers, and this law won't stop it either. Without a strong regulatory agency, this is an empty gesture.


Um, what? Why wasn't that one of the immediate things?

The insurance companies need a couple of years to figure out how to get around it.
posted by Pope Guilty at 8:31 PM on March 21, 2010 [18 favorites]


You should not denigrate the mission of the USS Abraham Lincoln.

Karl Rove: king of comedy!
posted by Jimmy Havok at 8:31 PM on March 21, 2010 [2 favorites]


maybe no repeal, but the lawsuits will fly. call me debbie downer but the crazies on the right don't just roll over...
posted by victors at 8:32 PM on March 21, 2010


Jesus never said anything about low taxes getting you into heaven, though he might have had a kind word or two for those who helped their fellow man.

CAN I GETTA AMEN?
posted by archivist at 8:32 PM on March 21, 2010 [12 favorites]


Despite all it's failings, it paves the way for real healthcare reform in the future. I have a feeling that once Americans get a taste of universal healthcare, they will never turn back just like Europe, Australia and Canada to name a few.

How does it pave the way? Seriously. To me what it looks like is that any future bill will be framed in terms of 'subsidies' to poor people. Plus, much of the cost savings in the reform is based on the idea that if consumers just knew how much they were paying for health care now (i.e. make employee insurance benefits taxable and put the info on the W2) then market forces will rein in the health care bubble... which I think is basically crazy, ideology run amok.

The rest of the reform looks like more tinkering with the industry through Medicare/Medicaid changes. Medicare/Medicaid is already stressed and I can't imagine this not making things more of two-tiered system than before.
posted by ennui.bz at 8:32 PM on March 21, 2010 [4 favorites]


dsword: " No Obama didn't play the game perfectly.

Even while President Obama was saying that he thought a public option was a good idea and encouraging supporters to believe his healthcare plan would include one, he had promised for-profit hospital lobbyists that there would be no public option in the final bill.
posted by Joe Beese at 8:32 PM on March 21, 2010 [1 favorite]


Obama 1, Fox News 0
posted by starman at 8:32 PM on March 21, 2010 [2 favorites]


I believe there was a post in the Teabag thread that explained that this will save money. It was reposted from another thread by the original poster.

If they drop by I'd like to read it into the record, once again.

I may just search for it when I'm not dancing around the room.
posted by Splunge at 8:33 PM on March 21, 2010 [1 favorite]


Pope Guilty: "California's anti-rescission law hasn't stopped insurance companies from dumping unprofitable customers, and this law won't stop it either. Without a strong regulatory agency, this is an empty gesture."

THIS.
posted by Joe Beese at 8:33 PM on March 21, 2010 [3 favorites]


Actually, people who already have healthcare will see their premiums go down as more healthy-but-currently-uninsured people are forced to sign up.

How gullible do you have to be to believe that?
posted by HTuttle at 8:34 PM on March 21, 2010 [14 favorites]


That story about losing health insurance at the hair stylist mentioned how insurance companies throw on a surcharge if your employees get sick enough. Is this -- somewhere -- covered in the bill?
posted by jeather at 8:36 PM on March 21, 2010


From the reuters link.... "What happens in 2014: *Health plans no longer can exclude people from coverage due to pre-existing conditions."

Um, what? Why wasn't that one of the immediate things?
There will be a separate government program for people who can't get regular insurance, that phases out in 2014. That goes into effect As soon as possible from what I understand.
posted by delmoi at 8:37 PM on March 21, 2010 [2 favorites]


Did they pass health care reform?
posted by raztaj at 8:38 PM on March 21, 2010 [5 favorites]


Imagine if African-Americans had to pay an artificially high amount to get coverage for Sickle Cell Anemia using a separate check because the Klan hated the idea of Black people being treated as humans.

There's a lot of reasons you could choose to argue against this bill, but your methodology with this one sucks. Pregnancy is not a hereditary disease, for starters...
posted by rollbiz at 8:38 PM on March 21, 2010 [4 favorites]


In the end this is a good thing. It's not the best thing, but it's a good step forward. Now onward to the other campaign promises!*

* Or things similar to the promises, but not quite the same thing, but still represent at least a nominal step forward.
posted by Atreides at 8:38 PM on March 21, 2010


Danila, with Medicare, no more donut holes for coverage. As a Medicare recipient, that one is really good for me. No more rationing migraine medication.
posted by angrycat at 8:38 PM on March 21, 2010 [2 favorites]


Even while President Obama was saying that he thought a public option was a good idea and encouraging supporters to believe his healthcare plan would include one, he had promised for-profit hospital lobbyists that there would be no public option in the final bill.

He's a ::gasp:: politician. OMG! Obama's not my BFF anymore. He made concessions to get a bill passed!

He didn't have a fucking choice. I hate that bullshit. Who FORCED him to remove the public option? Who essentially blackmailed him? The fucking right. Right?

Right.
posted by Splunge at 8:38 PM on March 21, 2010 [18 favorites]


I'm a freelancer planning to starting a family and still on the wife's COBRA, so while it's not perfect, I'm really glad this passed. I wish it started a little earlier (I may have to go on the yucky individual market for a while) and I won't be receiving any subsidies, but if the rules are fair, I think it's a pretty vast improvement what we had before, and given how heavy the political lift it was, I doubt much more would've been possible at the moment.

I'd love to see a public option added, and I think it can happen at some point soon.
posted by condour75 at 8:38 PM on March 21, 2010 [4 favorites]


Touchdown!
posted by Ironmouth at 8:39 PM on March 21, 2010


Don't worry patriots. The Texas AG has your back.
posted by birdherder at 8:39 PM on March 21, 2010


Now that it's passed, can someone provide a succinct list of what will change?

Crooks and Liars says:

- Adult children may remain as dependents on their parents’ policy until their 27th birthday
- Children under age 19 may not be excluded for pre-existing conditions
- No more lifetime or annual caps on coverage
- Free preventative care for all
- Adults with pre-existing conditions may buy into a national high-risk pool until the exchanges come online. While these will not be cheap, they’re still better than total exclusion and get some benefit from a wider pool of insureds.
- Small businesses will be entitled to a tax credit for 2009 and 2010, which could be as much as 50% of what they pay for employees’ health insurance.
- The “donut hole” closes for Medicare patients, making prescription medications more affordable for seniors.
- Requirement that all insurers must post their balance sheets on the Internet and fully disclose administrative costs, executive compensation packages, and benefit payments.
- Authorizes early funding of community health centers in all 50 states (Bernie Sanders’ amendment). Community health centers provide primary, dental and vision services to people in the community, based on a sliding scale for payment according to ability to pay.


Reinforced by non-neocon conservative columnist David Frum:

No illusions please: This bill will not be repealed. Even if Republicans scored a 1994 style landslide in November, how many votes could we muster to re-open the “doughnut hole” and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25 year olds from their parents’ insurance coverage? And even if the votes were there – would President Obama sign such a repeal?
posted by ignignokt at 8:40 PM on March 21, 2010 [3 favorites]


Yay! A real political victory.
posted by Flex1970 at 8:40 PM on March 21, 2010 [1 favorite]


Waterloo.
posted by kirkaracha at 8:40 PM on March 21, 2010 [3 favorites]


There's a lot of reasons you could choose to argue against this bill, but your methodology with this one sucks. Pregnancy is not a hereditary disease, for starters...

What do you mean? You can't get pregnant if you have a Y chromosome.
posted by delmoi at 8:41 PM on March 21, 2010 [8 favorites]


YES. HE. DID.
posted by nevercalm at 8:41 PM on March 21, 2010 [3 favorites]


This health bill may not have worked without the recent spending orgies over bailouts and foreign wars. Those disasters caused many to realize that if we don't start spending money on our own needs, domestically, it will instead end up paying for more crimes at the top, which are looking more and more like the biggest frat pranks in history, rather than mere gross mismanagement and blind leadership.
posted by Brian B. at 8:42 PM on March 21, 2010 [3 favorites]


He didn't have a fucking choice. I hate that bullshit. Who FORCED him to remove the public option? Who essentially blackmailed him? The fucking right. Right?

Right.


Actually wrong. So-called, moderate, fiscally conservative but left-leaning bluedog democrats pretty much put the nail in the coffin on this one. They made it pretty clear early on that the public option wasn't going to fly. The right, on the other hand, was opposed to anything and everything, including the bill that just passed. It's not like they picked up some extra Republican votes by ditching the public option.
posted by drpynchon at 8:42 PM on March 21, 2010 [17 favorites]


The fact that virtually all student loans after July 1 will be federal loans is also rather historic. I think the best thing about that is the fact that this means in the future all student loans will qualify for income based repayment and loan forgiveness (after 20 years, instead of the current 25, and after 10 years for those in the human services).
posted by Danila at 8:42 PM on March 21, 2010 [17 favorites]


I'm glad that many on the left have still decided to treat this huge victory as a bad bill that will only cause bad things. Instead of, you know, doing the smart politically, and consistent with reality, thing of taking this as the huge victory it is and using it has a the stepping off point for further reform. Even if this exact bill itself isn't a good starting point, it's probably on the net positive, and using it as jumping off bill for beginning another era of good, progressive reform.

Wait, no I'm not glad. I'm not very surprised. And kind of sad. But I'm still happy tonight.
posted by skynxnex at 8:43 PM on March 21, 2010 [27 favorites]



At least the whole thing is a baby step in the right direction. Right now it's a big giveaway to the insurance companies, but I can't help but think we'll see further improvement in regulation and hopefully some real cost controls once budgetary concerns force the issue.


Is this what we're banking on? Hope for "improvement in regulation" and "real cost controls?" I don't know where you were during the recent mortgage industry bailout, but all right, I guess you're way more optimistic than I am.

The way I see it, we couldn't have this bill without the support of insurance companies: the very same a-holes we were trying to regulate in the first place. Now we get to fork them over wads of cash. Really? Is this REALLY a democrat we elected to office? Right now I am positively floored.

I have to hand it to Obama: the guy has had enough charisma to push through a bill that liberals would have screamed bloody murder over, should any republican president have tried to pass it.

Anyways, on the bright side, I haven't had health insurance, and now I'm going to get some. I am seriously consider taking up the riskier activities I've been avoiding for the past few years because I lacked health insurance (snowboarding, for one.)

So, yay for that?
posted by The ____ of Justice at 8:44 PM on March 21, 2010 [2 favorites]


On one hand: No public option, there's an end run around pro-choice rights, and insurance companies get millions of customers with no cost controls.

On the other hand: Fuck the Teabagger Party.
posted by Blazecock Pileon at 8:44 PM on March 21, 2010 [8 favorites]


Live address from the White House starting now.
posted by donnagirl at 8:45 PM on March 21, 2010


drpynchon: "He didn't have a fucking choice. I hate that bullshit. Who FORCED him to remove the public option? Who essentially blackmailed him? The fucking right. Right?

Right.


Actually wrong. So-called, moderate, fiscally conservative but left-leaning bluedog democrats pretty much put the nail in the coffin on this one. They made it pretty clear early on that the public option wasn't going to fly. The right, on the other hand, was opposed to anything and everything, including the bill that just passed. It's not like they picked up some extra Republican votes by ditching the public option.
"

Citation please. Show me the facts and I'll admit my ignorance.
posted by Splunge at 8:45 PM on March 21, 2010


As a physician, let me say to people like Malor and anyone else who believes they know the eventual downstream effect of this - please stop and admit you are talking completely out of your ass. Whatever meticulous analysis and metrics one can bring to this, you are ultimately talking about changing the paradigm of healthcare from a game of roulette no different than being born into a wealthy family in a developed nation or a slum in Somalia. From the simple fact that insurance can't be denied for pre-existing conditions you have changed the way the dialogue on care will proceed. It is akin to a declaration that a black person is not a second-class citizen.

The current model of healthcare will bankrupt us, just in lots of unquantifiable, small, invisible steps. It is conceivable that in a model where all of us have a stake in the outcome and costs we may actually start having a dialogue on real matters of health. We may actually start teaching people from a young age how to properly care for themselves. We may start rural health care clinics where midlevels with decent training manage chronic disease instead of people wandering into the community ED from the hills after a tumor has eaten through their abdominal wall (yes, it happens).

Grow a fucking pair and try to keep an open mind.
posted by docpops at 8:46 PM on March 21, 2010 [230 favorites]


Joe Beese:

There comes a time when your inner need to have your highly repetitive Very Strongly Held Opinions heard at top volume by all present becomes detrimental to the group (for instance, driving people away from threads to which they might otherwise contribute interesting observations) and, in fact, begins to drain the effectiveness of your persuasion.

In your case, that time passed months ago, but I urge you (hopelessly, I know) to look on this thread as your opportunity to practice listening. For, you know, 10 minutes or something.
posted by argybarg at 8:46 PM on March 21, 2010 [41 favorites]


After a year of hearing teh crazy from both sides of the political spectrum over this thing, I feel like I'm just coming u for air after being trapped underwater for what seems an eternity.

Without going into specifics, this legislation will directly help three members of my family. It will indirectly help me, as well, on at least two fronts.

Best legislation? No. A good step forward? Yes. Things needed to be fixed? Sure. Will the insurance companies figure out a way to find loopholes and still make a mint off of it? Of course.

Still, a real victory for progressives and for the country? Definitely.
posted by darkstar at 8:47 PM on March 21, 2010 [6 favorites]


The Feminist Case for Flawed Reform.

Joe Beese and Pope, what is your alternative strategy? Let it fail? Never have a vote? Dream of a substantially more liberal electorate that would pass the bill you want? Continue grousing ineffectually?

Tonight is a start. A long way to go, but it's a start. And now, the President of the United States...
posted by Kwine at 8:47 PM on March 21, 2010 [17 favorites]


angrycat: "Danila, with Medicare, no more donut holes for coverage. As a Medicare recipient, that one is really good for me. No more rationing migraine medication."

Yeah, that's a really great benefit. My medications never cost that much (I consume more in services than medications, so the service and benefit cuts are what I noticed first), but I know the huge hole costs thousands of dollars that people don't have. Ten years ago Medicare didn't cover prescription drugs at all, and now it looks like they will be covered completely. Big shift.
posted by Danila at 8:47 PM on March 21, 2010 [1 favorite]


Actually wrong. So-called, moderate, fiscally conservative but left-leaning bluedog democrats pretty much put the nail in the coffin on this one.
Well, house asside, once they decided to do this via reconciliation, they could have added the public option, or a medicare buyin to the "sidecar" but they didn't. But they can also add the public option any future legislation too.

Adding the public option in the future will be easier with this bill passed, IMO.

I would at least have liked to see a vote though.
posted by delmoi at 8:48 PM on March 21, 2010


There comes a time when your inner need to have your highly repetitive Very Strongly Held Opinions heard at top volume by all present becomes detrimental to the group (for instance, driving people away from threads to which they might otherwise contribute interesting observations) and, in fact, begins to drain the effectiveness of your persuasion.

In your case, that time passed months ago, but I urge you (hopelessly, I know) to look on this thread as your opportunity to practice listening. For, you know, 10 minutes or something.


Take it to Metatalk, please.
posted by Blazecock Pileon at 8:48 PM on March 21, 2010 [10 favorites]


What do you mean? You can't get pregnant if you have a Y chromosome.

If you're not kidding, and you really want to make an argument detailing the similarities between sicke cell anemia and pregnancy, you go right ahead. I'll let the ridiculousness of that proposition stand for judgement.
posted by rollbiz at 8:50 PM on March 21, 2010 [1 favorite]


I have been watching coverage on these votes for four hours now, wasting away my Sunday evening with fine political theater. John Boehner was my favorite performer of the evening - his heart wrenching "Hell no you can't" retort was simply fantastic.

But overall, I watched all of this with a lot of joy. Like watching a football game, I was IN this tonight, I was cheering on the team. For the first time, THE FIRST TIME truly, I feel validated in my vote, in my President. CHANGE - true, bipartisan change (over 200 Republican amendments in the bill) - has prevailed.

Mr. Boehner:

Hell yes we can and hell yes we DID.
posted by deacon_blues at 8:51 PM on March 21, 2010 [10 favorites]


drpynchon: Wouldn't a sensible, clear-eyed definition of the "right" include not only the Republicans but also those "so-called moderate" blue dogs? That's certainly my working definition of the term (which is, of course, sensible and clear-eyed), and it's not uncommon for people to point out that America's Left is Europe's Center.
posted by col_pogo at 8:51 PM on March 21, 2010 [2 favorites]


Citation please. Show me the facts and I'll admit my ignorance.


Umm. 178/178 registered Republicans voted against the current bill. I'm failing to see how getting rid of the public option one any of them over. I'm going to invoke common sense on this one.
posted by drpynchon at 8:53 PM on March 21, 2010 [2 favorites]


If you're not kidding, and you really want to make an argument detailing the similarities between sicke cell anemia and pregnancy, you go right ahead. I'll let the ridiculousness of that proposition stand for judgement.

The point is, black people don't have a choice about being more likely to be affected by sicke cell anemia, and women don't have a choice about being more likely to be pregnant. Also, most African Americans aren't affected anyway, while most women are.
posted by delmoi at 8:54 PM on March 21, 2010 [5 favorites]


Look how hard it was to get this passed, and it's incremental change, not the sweeping change many of us wanted. It's a big step in the right direction. I think they calibrated the bill as closely as possible, to get it passed, while preserving as much of the intent as they could.

I truly don't understand why so many who will benefit from health care reform fear it so much.
posted by theora55 at 8:54 PM on March 21, 2010 [1 favorite]


Why do people think that this is some kind of first step? The Dems tore their nails out and compromised every good idea that could've gone into the bill in order to pass a bill that is, to be blunt, a piece of shit. This is the best the Dems could do, and it only barely squeaked by.

Fantasies about further legislation that makes it better are either willfully or tragically ignorant of the realities of the political demographics of the House and Senate, and it's a real shame to see this kind of relentless optimism about a political party that has demonstrated over and over again that their interests are with the corporations that fund their campaigns and not with either the people or even their constituents.

This whole "Well we could get a public option in a future bill!" fantasy relies on the entire country moving substantially to the left. I only wish I could be so thoroughly deluded.
posted by Pope Guilty at 8:55 PM on March 21, 2010 [9 favorites]


drpynchon: "Citation please. Show me the facts and I'll admit my ignorance.


Umm. 178/178 registered Republicans voted against the current bill. I'm failing to see how getting rid of the public option one any of them over. I'm going to invoke common sense on this one.
"

Facts. Not anecdata. Show me the facts.
posted by Splunge at 8:56 PM on March 21, 2010


Folks - health care reform as a concept has PASSED (effusive question marks deleted)

Yes it's flawed work. But the really really hard work - starting the HCR ball rolling, really rolling! - it's done. Like the Glum Frum has stated, it will not be repealed.

Going forward, people can now begin to fight for specifics. Pick your favourite health care weakness, join up with like-minded people, and start pressuring your Senator or congress-critter now. Move forward.

It's a good day.
posted by Artful Codger at 8:57 PM on March 21, 2010 [20 favorites]


donnagirl, thanks for that. I bet Obama sleeps well tonight.
posted by Dasein at 8:58 PM on March 21, 2010


The Presidential Executive Order is meaningless; Stupak was just posturing for a pro-life position. I'm not sure how it gets translated as women's reproductive rights being a "bargaining chip".

Also, this is very much a WIP; I'd recommend against popping corks too soon.
posted by the cydonian at 8:58 PM on March 21, 2010


Just wanted to say that this makes me a lot more optimistic about starting my own small business.
posted by breath at 8:59 PM on March 21, 2010 [3 favorites]


This is gonna be as awesome as medicare d!!!!!!
posted by mandymanwasregistered at 9:00 PM on March 21, 2010 [1 favorite]


DOOM
posted by Mach5 at 9:02 PM on March 21, 2010


I meant to add that the GOP will probably be first out out of the block with shiny health-care add-ons in time for the Nov elections.
posted by Artful Codger at 9:03 PM on March 21, 2010


- Adult children may remain as dependents on their parents’ policy until their 27th birthday

This is a big one for me since I have a twenty year old child who probably won't be able to afford his own insurance for a few more years. I'd hate to think that he could get into an accident or get sick and be horribly burdened by debt from the medical bills.
posted by octothorpe at 9:03 PM on March 21, 2010 [2 favorites]


From up here in Canada it looks like Obama and the Democrats (at least those that voted with him) won a semantic battle, that might even be a moral battle, that might be a significant push down the slope toward a more universal system that cares for all its citizens when they are sick and injured, regardless of income or insurance level.

This past Thursday (Day 1) a good friend, who'd been having increasingly painful headaches for the past week, passed out at a meeting. When she came back to consciousness she couldn't remember her name, etc. They took her to emergency where the initial sense was that she had an aneurysm. They admitted her, ran tests (MRI etc.) and changed the diagnosis. She had a Colloid cyst, which was expanding and causing pressure on the brain. They immediately took her to the OR and put in two shunts to relieve the pressure. They monitored her the next day (Day 2), confirmed the diagnosis, and scheduled her surgery to remove (hopefully) the cyst. At 7:30 AM on the next day (Day 3) she was in the OR, and after 4 hours of surgery, most of the cyst was removed, and she was in ICU recovering.

Not once did she, or her family, or her friends, worry about finances or quality of care. We concerned ourselves with caring for her and each other. The healthcare system took care of her healthcare needs. You will hear about the Danny Williams of Canada, who choose alternate ways to address their needs. They do so because they have money to spend on tans, while they have heart surgery. You will hear about people who wait to have hip surgery, but these people are likely functional, and not in mortal danger. When people are sick and emergent in Canada, they get timely care from caring, competent professionals. Nobody, not the patient or the caregiver, worries about whether an insurance company will scrutinize the kind of care they receive or provide.

It's nice like that.
posted by kneecapped at 9:03 PM on March 21, 2010 [83 favorites]


This bill passing means that if I have some sort of major medical problem and lose my job, it's at least somewhat less likely that I'll go bankrupt and die. So regardless of whatever bullshit is involved I'm going to go ahead and call this a good thing.
posted by burnmp3s at 9:04 PM on March 21, 2010 [18 favorites]


Pope Guilty: "Fantasies about further legislation that makes it better are either willfully or tragically ignorant of the realities of the political demographics of the House and Senate, and it's a real shame to see this kind of relentless optimism about a political party that has demonstrated over and over again that their interests are with the corporations that fund their campaigns and not with either the people or even their constituents."

Those NAFTA improvements should be along any day now.

And as a cherry on the sundae: $50 million annually for abstinence-only sex education.
posted by Joe Beese at 9:05 PM on March 21, 2010 [3 favorites]


Yes, this bill is flawed. There are things I hate about it, and I'm enraged and saddened that apparently the only way to pass any kind of health care reform was to give a nod to those whose ultimate goal is to outlaw abortion.

And yet I'm still sitting here, tears practically streaming down my face, because I'm thinking about all the things that are good about this bill, and about all the tragedy and injustice and stupidity of the current health care system. I'm thinking about my younger sister, who has craptacular insurance on her own but may now be able to revert to coverage under our mother's infinitely better policy, and about all the people in situations like hers and way way worse.

So yeah. When I think back on this day, it's possible that I'll realize it was a terrible mistake, that this was the wrong bill, that it was just one blip in the whole landscape of failed healthcare policies in the US. But right now I kind of doubt it.
posted by chalkbored at 9:06 PM on March 21, 2010 [11 favorites]


If they're anything like the cheaper plans available now- and there's nothing preventing that- the answer is "ruinous".

In our current healthcare systems, there are varying levels of 'ruinous'. If I develop some sort of brain cancer or something, and am forced to pay 80k out of pocket for treatment and whatnot, or however high the cheap plans are, that is *still* better than the 800k it most likely will actually cost without any insurance.
posted by graventy at 9:07 PM on March 21, 2010 [2 favorites]


You, know, exactly what other people are saying. Yeah, it's not UHC, or the public option. But it does take us int he right direction. And it is something that hasn't been done in fucking decades. Done in he face of mounting threats of violence, done despite every single fucking conservative talking head pronouncing it dead and the worst idea since anthrax, done despite congress being essential broken by the current crop of Republicans, done despite an entire major news organization doing everything except getting on the floor and voting against it.

And yet we have many on the "left side" who would piss int he water and not only, rightfully so, point out the flaws but decry it's passage and insist on a perfect bill or no bill at all. The Stupak melodrama was fucking absurd, yet Stupak came away with peanuts. Nothing actually new happens to federal funding irt abortion in either the Senate or House bills. Obama didn't negotiate away anything in regards to that. Yeah, you know I actually would have loved the Hyde bullshit be stripped from federal law, but as balanced on a knife edge as this whole thing was that wasn't going to happen. And no amount of bullying by the president, or senior members Dem members would have changed that.

This was a win, not a pretty win but a win. And I wish people could breath a few hours before the drive by link-tastic backbiting commenced.
posted by edgeways at 9:08 PM on March 21, 2010 [7 favorites]


“$75 million per year through FY2014 for Personal Responsibility Education grants to States for programs to educate adolescents on both abstinence and contraception for prevention of teenage pregnancy and sexually transmitted infections, including HIV/AIDS.”
posted by edgeways at 9:12 PM on March 21, 2010 [1 favorite]


Yeah! Cynical, snide remarks are the best way to solve social injustice!
posted by oinopaponton at 9:12 PM on March 21, 2010 [7 favorites]






Joe Beese: "Pope Guilty: "Fantasies about further legislation that makes it better are either willfully or tragically ignorant of the realities of the political demographics of the House and Senate, and it's a real shame to see this kind of relentless optimism about a political party that has demonstrated over and over again that their interests are with the corporations that fund their campaigns and not with either the people or even their constituents."

Those NAFTA improvements should be along any day now.

And as a cherry on the sundae: $50 million annually for abstinence-only sex education.
"

Can either of you really be serious about this crap? That's republicans. In a nutball. Damn.
posted by Splunge at 9:12 PM on March 21, 2010


"Jesus never said anything about low taxes getting you into heaven, though he might have had a kind word or two for those who helped their fellow man"

If I favorited this any harder I might sprain something.
posted by mr_crash_davis mark II: Jazz Odyssey at 9:12 PM on March 21, 2010 [3 favorites]


edgeways: "... I wish people could breath a few hours before the drive by link-tastic backbiting commenced."

You'll find Party Central over at Daily Kos - where one of the currently top-rated diaries is titled "Already one of the GREATEST PRESIDENTS EVER. (Update with GREAT PHOTO)".
posted by Joe Beese at 9:13 PM on March 21, 2010 [3 favorites]


Congratulations, USA. That's two steps you've taken forward: electing Obama, and getting healthcare. You're back on the right path.
posted by five fresh fish at 9:13 PM on March 21, 2010 [4 favorites]


Splunge:

Blue Dog Democrat Comes Out Against Public Option
Collin Peterson's Blue Dogs bark at 'public option'
Public Option killed by Blue Dogs in Senate Finance Committee
posted by Serf at 9:14 PM on March 21, 2010 [1 favorite]


I'm out of here. My irony meter just exploded. I just... Nevermind. I have to go.
posted by Splunge at 9:15 PM on March 21, 2010


Woot! I can keep my mom's health insurance for a few more years!
posted by hellojed at 9:15 PM on March 21, 2010 [4 favorites]


Everyone has to buy insurance, and those who can't afford good plans are going to get cheap plans, and cheap insurance is only better than no insurance if you're racking up enough costs to get over the ridiculous deductibles and co-pays.

Oh, I don't know. I had major medical, but it also included some preventative coverage stuff like one free doctor's visit/year as well as a copay for visits. My insurance had a crazy huge deductible; I would have had to pay a good $7-8k or so before the insurance company started paying real money. Even so, I was glad I had it. I mean, $10k would have been real hard had it happened, but if something bad had happened (which is what health insurance is really for) at least it would have stopped there instead of costing me tens of thousands of dollars.

Unfortunately this is not really a health reform bill; or, if it is, that's taking a back seat. This is really a health insurance reform bill which seeks on the one hand to widen the net of insured (which will hopefully lower costs) but also make it harder for insurance companies to deny coverage or refuse coverage.

My favorite part is that W2s will soon disclose exactly how much of your salary is going towards health insurance. I only hope that people see that and then start thinking that single payer might be a good idea after all.
posted by Deathalicious at 9:16 PM on March 21, 2010 [6 favorites]


it's a real shame to see this kind of relentless optimism about a political party that has demonstrated over and over again that their interests are with the corporations that fund their campaigns and not with either the people or even their constituents."

Can either of you really be serious about this crap? That's republicans. In a nutball. Damn.

If you're operating on the idea that that's the Republicans, and that the Democrats are somehow virtuous agents of the wellbeing of the people, you're pretty naive.
posted by Pope Guilty at 9:16 PM on March 21, 2010 [6 favorites]


Yeah, maybe I will share a few specifics:

Last year, I lost my COBRA, having been out of full-time employment for over 18 months. I also have a pre-existing medical condition. So I could not qualify for any real insurance and was on the verge of losing my home because of medical expenses. I was in the position of having to decide whether I would give up my home and my part time job and become completely penniless so I could get medical care for the indigent.

I'm also supporting a disabled, elderly relative who has moved in with me. So if I lost my home, he would have had to go into a state-run nursing home.

For those of you who have never been in this situation, I don't think you can possibly begin to imagine what this feels like. The crushing, no-way-out sense of being completely trapped by cruel circumstances. The utter insult constituted by platitudes like "pull yourself up by your bootstraps". And the agonizing frustration of people who, well-intended, allow their hopes for ideal legislation to undermine making some real progress with good legislation.

Unless you have a sense of this, you can't understand what the Health Care Bill means to folks who are in situations like that, or why even a flawed bill is embraced with such passion. It's said that a drowming man will grab even the edge of a sword if it's offered to him. Well, a lot of drowning people just got offered something rather better.

It's not perfect, but it's like, real help. It's not just carping about politics on an online forum or moaning about how much the insurance industry is going to make or giving prognostications about what it will mean for our country. It's serious and it's deeply personal.

I'm grateful that, since then, my personal fortunes have changed. I'm lucky enough to have a great job with employer-provided insurance. But I'm acutely aware of just how close I've been to ruin, and how recently. And for their work to help craft and pass a law that helps keep that particular wolf from the door, I'm very grateful to progressives, moderates and the Democratic leaders in Congress and the White House. And for my vote for Obama, I couldn't be happier.

So to answer Sarah Palin's question about that hopey changey thing? It's working out pretty well.
posted by darkstar at 9:20 PM on March 21, 2010 [190 favorites]


Relentless pessimism is awesome.
posted by Artw at 9:20 PM on March 21, 2010 [4 favorites]


Just one more thing...
Fuck yes!
posted by ohyouknow at 9:21 PM on March 21, 2010


This legislation is a miserable failure. It's ruthlessly discriminatory - most of its benefits are expressly written to exclude women and minorities. It claims portions of my paycheck for the government, and I'm not even allowed to opt out. It's going to be manifestly unpopular.
posted by grrarrgh00 at 9:24 PM on March 21, 2010 [13 favorites]


</subtlejab>
posted by grrarrgh00 at 9:25 PM on March 21, 2010


I'd like to know the name of the fuckhead who called Stupak a "baby killer."

And I'd like Stupak to know that despite my referring to him as Stupad all morning I stood up and cheered when he finally said that a real party of life cares enough to make sure babies with pre-existing conditions and mothers with less than ideal jobs and people, period are able to obtain health insurance and health care.
posted by sallybrown at 9:25 PM on March 21, 2010 [9 favorites]


I'm happy the bill passed. I honestly didn't think it was going to happen and I'll admit I simply enjoy watching right-wing lunatics seethes on a superficial level.

I just wish the bill was good. I hope it does everything people claim it will, but history shows it probably won't. Thinking it's going to made better after what this took, and in a perilous election season no less, is incredibly naive.
posted by XQUZYPHYR at 9:25 PM on March 21, 2010 [1 favorite]


My insurance had a crazy huge deductible; I would have had to pay a good $7-8k or so before the insurance company started paying real money. Even so, I was glad I had it. I mean, $10k would have been real hard had it happened, but if something bad had happened (which is what health insurance is really for) at least it would have stopped there instead of costing me tens of thousands of dollars.

This is the crux of my opposition: if we really want better health care- and cheaper health care- we need to get people in to see GPs. Shitty, bottom-tier insurance with high deductibles and co-pays does nothing to accomplish that.

This isn't health care reform. This is "everyone is legally required to give a bunch of money to the insurance companies, and in exchange a small number of people are less likely to be driven to bankruptcy, though they'll still be driven deeply into debt". And people are cheering for that as if it were the second coming.
posted by Pope Guilty at 9:25 PM on March 21, 2010 [5 favorites]


This legislation is a miserable failure. It's ruthlessly discriminatory - most of its benefits are expressly written to exclude women and minorities. It claims portions of my paycheck for the government, and I'm not even allowed to opt out. It's going to be manifestly unpopular.

You think so? You can make the same case for Medicare and Medicaid. Go ahead and try to eliminate those programs and see how popular they are.
posted by Astro Zombie at 9:25 PM on March 21, 2010 [1 favorite]


Woo, someone didn't highlight his link.
posted by graventy at 9:27 PM on March 21, 2010 [12 favorites]


*Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidized insurance on the exchange. The first 30 employees aren't counted for the fine.

Does anybody have information on how this will play out for, say, Wal-Mart? Is this all employees, or just FTEs?


My understanding is that the employer must count two part-time employees as a single full-time employee in the calculations. I love this because it seems designed to get at employers like Walmart and UPS whose strategy is to keep as many employees as possible just beneath the threshold of hours needed to qualify for benefits.
posted by fallacy of the beard at 9:28 PM on March 21, 2010 [5 favorites]


Do people imagine that they were raised in an Hobbesian state of nature, and that what they have is theirs by virtue of their own endeavours and nothing else?

Here in America? Yes. We call them "conservatives". And that is basically their entire platform.
posted by emjaybee at 9:29 PM on March 21, 2010 [38 favorites]


I think that the most important victory here is that the US government has finally acknowledged that healthcare is actually a right and not a privilege. The bill is far from perfect but it goes much farther toward the goal of insuring that right than we've ever gotten before and we're just going to have to keep pushing to make it incrementally better in the future. This is a good thing, possibly even a great thing.
posted by octothorpe at 9:30 PM on March 21, 2010 [3 favorites]


Do people imagine that they were raised in an Hobbesian state of nature, and that what they have is theirs by virtue of their own endeavours and nothing else?

Yes, they do. These are the same people who have deluded themselves into thinking their wealth is created completely independent of the contributions of their employees, customers, their vendors, the public schools (and federal student loans) that have educated their employees, customers, and vendors, and the numerous government services, subsidies and regulations for things like electricity, running water, paved roads, cheap U.S. Postal Service first class mail, and internet that make their businesses possible.
posted by MegoSteve at 9:31 PM on March 21, 2010 [73 favorites]


You know what else was a disappointing mess of a bill that was weak and watered down and still filibustered relentlessly by the opposition?

The Civil Rights Act of 1964.

So, maybe what happened tonight is, like the Civil Rights Act, the foundation for what comes after.
posted by dw at 9:31 PM on March 21, 2010 [25 favorites]


The Civil Rights Act of 1964 didn't mandate that people give money to the KKK.
posted by Pope Guilty at 9:33 PM on March 21, 2010 [2 favorites]


HCR mandates people give money to the KKK?
posted by mazola at 9:35 PM on March 21, 2010 [28 favorites]


The Civil Rights Act of 1964 didn't mandate that people give money to the KKK.

Not every parallel must be exact. You pass what you can, and try to make it what you wish it could be. Making law in the country is the most imperfect of exercises. Democracy fails every step of the way, and succeeds only by plodding from failure to failure until they amount to something like success.
posted by Astro Zombie at 9:35 PM on March 21, 2010 [4 favorites]


This is a step in the right direction. I'm happy for my kids.
posted by Songdog at 9:37 PM on March 21, 2010


I only hope that, with health care reform, Holly from the Liberator Medical Supply commercials won't have to boil and reuse her old catheters any more.
posted by MegoSteve at 9:38 PM on March 21, 2010 [5 favorites]


As I approach 40, I've had to come to terms with the idea that the perfect is the enemy of the good. And just as much as that applies to my personal life, I believe it applies to the political sphere as well. Would I have liked to see UHC or single-payer? Yes. Would I liked to see the removal of restrictions on abortion? Hell yes.

But the fact that millions of people will now have access to health care, without the fear of losing their homes or going bankrupt? That's a good enough start for me. My daughter wanted to know why this mattered. I told her that it means that people who couldn't see the doctor because they couldn't afford it could probably go to the doctor when they're sick now. And she got it. Again, that's good enough for me, right now, for a start.
posted by Lulu's Pink Converse at 9:38 PM on March 21, 2010 [19 favorites]


This is the crux of my opposition: if we really want better health care- and cheaper health care- we need to get people in to see GPs. Shitty, bottom-tier insurance with high deductibles and co-pays does nothing to accomplish that.

You know what does help, though? Free annual physicals. Included in the bill. Any person with an MPH would tell you that regular annual physicals make a difference with health.

And also keep in mind that shitty, bottom-tier insurance with high deductibles and co-pays are what we've had with the car insurance universal mandate. The result, though, has been very, very few people bankrupted by a car crash. Car insurance premiums have been relatively steady as a result of the universal mandate.

It IS better than nothing. Universal healthcare would be far better, but that will wait another day. This is the closest the US has been to universal care, which is sad, but is also a huge improvement over the high-rate Babylon we were slouching for.
posted by dw at 9:38 PM on March 21, 2010 [11 favorites]


Look, I don't think anyone is overjoyed with the content of the bill itself, PG. We're just happy that something passed. It's crossing a line; after this point, no one can really say that the government isn't or shouldn't be in the health care business.

Okay, for example: you say that a lot of these provisions are pointless without a strong regulatory agency. Without this bill, there'd be nothing in place to support the creation of such an agency a few years down the road.

Yes, people will be forced to pay for health care. My understanding is that for people who can't afford it on their own will get help. My guess is when that happens, we'll see a large group of individuals who don't consider themselves poor -- and who aren't considered poor by the general population -- turning to the US government for help in paying for their health care (in the form of reduced-cost insurance premiums). Assuming the teabaggers don't all decide to break the law, many of them will be writing in to the government, asking them to pretty please help them out. For all those people, they might come to see the government as an entity that gives in addition to receiving.

Yeah, this is a crappy bill for what we wanted. But I think it's a game changer, and really for now that's enough.
posted by Deathalicious at 9:39 PM on March 21, 2010 [5 favorites]


The Civil Rights Act of 1964 didn't mandate that people give money to the KKK.

Dude. Put down the tea bag and walk away.
posted by dw at 9:40 PM on March 21, 2010 [12 favorites]


If you're operating on the idea that that's the Republicans, and that the Democrats are somehow virtuous agents of the wellbeing of the people, you're pretty naive.

Neither party is a monolith, although the Republicans become more so all the time.
posted by Jimmy Havok at 9:41 PM on March 21, 2010 [2 favorites]


So... Glenn Beck's show should e a big bucket of LOLZ tomorrow, right?

This is certainly better than nothing and will hopefully do some good for the big pile of friends I've got who lack insurance some good.
posted by sparkletone at 9:41 PM on March 21, 2010 [1 favorite]


First off, this changes the lives of a LOT of people for the better, so yay. Seriously, YAY!

Second, if anybody would like to know why the people with the best arguments and the facts on their side (almost!) never get anything done, see this thread.
posted by lattiboy at 9:41 PM on March 21, 2010 [2 favorites]


Joe Besse: You'll find Party Central over at Daily Kos - where one of the currently top-rated diaries is titled "Already one of the GREATEST PRESIDENTS EVER. (Update with GREAT PHOTO)".

Yeah, because that was actually exactly what I was doing. {/}

Somewhere between their hyperbolic cheer and your hyperbolic doom and gloom lies sanity. Jesus Joe, sometimes I get the feeling Obama came and pissed in your corn flakes personally. I get it, you want things to be better, so do I, but you honestly come over as one of the most bitter people around here. People are working hard to effect some sort of positive change and the first words out of your fingers is essentially that it is not enough and what happened sucks. Admittedly I don't have a clear picture of you, this is just the internet, but irt politics it's like a John Giorno piece about how everything sucks and we are all screwed. As much as we may be actually on the same side on the vast majority of issues, it just gets really tiring being beat over the head by someone consistently saying there is nothing good and so and so hates it look here's proof it all sucks. I actually had to break off most relations with my mother over the last year or so because that is exactly the litany coming from her.

Look, I am no Pollyanna. I am perfectly able to see many of the flaws of what happens yeah, our system of governance is pretty whack on many levels, but it is something so systemic that bitching about it on the internet does absolutely zero to change it, which is why I actually am fairly involved in local politics.

Tell me something concrete to do along with the incessant bitching, tell me something to do other than get angry, because there is just too many things to be angry about and I'm tired of it. It has worn me out.
posted by edgeways at 9:42 PM on March 21, 2010 [42 favorites]


Heh:
Did they come up with this brilliant plan after Stupak has made it clear that his contempt for women’s opinions applies even to nuns? Is it possible that Nancy Pelosi called up Obama and said, “Look, I’ve been telling him and Sebelius has been telling him there’s no federal funding for abortion in this bill. He apparently needs to hear it from a man, so can you give us a hand?”
posted by XQUZYPHYR at 9:43 PM on March 21, 2010 [7 favorites]


Look, I don't think anyone is overjoyed with the content of the bill itself, PG. We're just happy that something passed.

Look, I'm hip to that, and I understand that people think that this is some kind of first step. I just think that that's a huge mistake.


Dude. Put down the tea bag and walk away.

Oh for fuck's sake, I'm done here. Enjoy your celebration of the betrayal of your values.
posted by Pope Guilty at 9:44 PM on March 21, 2010 [4 favorites]


I'm a bit terrified to see what becomes of the Tea Party. This could mimic the disillusionment of the left in the 60s and the 70s, where they rejected the Democratic Party, and, as the disillusionment deepened, some strayed further and further into violent activism. We could be looking at a splintering that leads to the right wing versions of the SLA, the Weather Underground, and Manson. And those guys were so far on the fringes as to have left mainstream politics altogether. I have a feeling the GOP will fund and try to make use of their fringe right up until the moment the homemade bombs go off.
posted by Astro Zombie at 9:47 PM on March 21, 2010 [12 favorites]


Thanks Pope Guilty and Joe for showing me the light. You guys are right things will never get better and we shouldn't try to accomplish anything at all. Let's just all sit around and bitch at any conceivable idea for change that comes up.

I'm glad you guys are here to tell us how shitty life has become under the Obama administration. This bill that was just passed is obviously more harmful than not doing anything and we have you two to bring that up.

I mean the civil rights bill? Didn't do enough and was a waste of time.

The medicare bill? An insurance and hospital bailout.

Also Obama is a war criminal since he like fights wars and stuff and we really should impeach him.

Man, must feel good to see the world with a face covered with shit. Too bad that's all that comes out of your mouths.
posted by Allan Gordon at 9:50 PM on March 21, 2010 [11 favorites]


Oh for fuck's sake, I'm done here. Enjoy your celebration of the betrayal of your values.
Oh please, other then a few upper middle class healthy people who don't want to buy insurance, this pretty much makes everyone better off. Could it be better? Absolutly, but it's an improvement over the current situation.

I hate the lack of a public option. It's B.S. But it can be added much more easily in the future, with all the other pieces in place.

Remember, there's also a huge expansion of Medicate for poor people and lower middle class.
posted by delmoi at 9:53 PM on March 21, 2010 [1 favorite]


Oops, I should say "mediCARE for poor and lower class"
posted by delmoi at 9:55 PM on March 21, 2010


We could be looking at a splintering that leads to the right wing versions of the SLA, the Weather Underground, and Manson.

It wouldn't surprise me to see factions of the Tea Party evolve into just this. Of course, there have already been violent right-wing acts in the U.S. since Obama was elected, like the white supremacist who murdered a guard at the Holocaust Museum, that guy in Pittsburgh who shot up the cops thinking that Obama was going to take his guns, and the tax cheat who flew his plane into the IRS building in Texas.
posted by MegoSteve at 9:55 PM on March 21, 2010 [9 favorites]


Related to all this: Those assholes who called Barney Frank a faggot to his face can all suffer from genital punchitosis (a disease in which it feels like you are being punched in the whatever-you've-got constantly) as far as I'm concerned. Good thing they'll have a better shot at affording treatment soon!
posted by sparkletone at 9:58 PM on March 21, 2010 [2 favorites]


Also wanted to say, . . . I told you so. Everyone thought it was fucked. But they got that done. Just as I said they would. "Plan B" worked.

Seriously, January and this thing looked so hard. March and we have it. Its about the second effort.

The best was Allen Boyd. That ol' Blue Dog shit got up there and fucking bellowed about how great the fucking bill it was. I loved that.

This President and this group did what they said they would. Their legislative record in 14 months is stunning, as is this victory. On January 20, 2005, if I would have told you that a Black liberal democrat was going to be President of the United States and that he would within the first year and a half, pass a giant stimulus that saved millions of jobs, passed a huge jobs bill, and passed a huge Health Care reform bill covering 36 million more people and cutting the deficit substantially, would you have believed it? All of this in the teeth of complete GOP resistance?

This guy is working on levels the GOP can't even see. He's done what TR, Roosevelt, Truman, JFK, Johnson and Clinton could not do.

and he's a liberal black guy. Its their kryptonite!
posted by Ironmouth at 9:58 PM on March 21, 2010 [88 favorites]


I have a feeling the GOP will fund and try to make use of their fringe right up until the moment the homemade bombs go off.

Just like they did with the militias and other groups in the early 90s, right up until the Ryder truck exploded in front of the Murrah building.

I'm afraid we'll see something similar within the next 24 months. Unfortunately, people will have to die before the rhetoric starts getting dialed down. And not just one IRS worker or a couple of Pentagon security guards, but mass carnage.
posted by dw at 9:59 PM on March 21, 2010 [5 favorites]


I'm having a hard time with some of the statements in this thread. So the argument is that the insurance industry and their Republican politicians opposed this bill as a bluff? I find that massively hard to buy.
posted by Bookhouse at 10:02 PM on March 21, 2010 [1 favorite]


It wouldn't surprise me to see factions of the Tea Party evolve into just this. Of course, there have already been violent right-wing acts in the U.S. since Obama was elected, like the white supremacist who murdered a guard at the Holocaust Museum, that guy in Pittsburgh who shot up the cops thinking that Obama was going to take his guns, and the tax cheat who flew his plane into the IRS building in Texas.

What interestes me is how many of the recent spate of crazy anti-tax lunatics going off on one have been software engineers. We're like the new postal workers or something.

That said, I have known a few people who are *exactly* that kind of software engineer.

* I kind of think of myself more as a web developer than a computer engineer though. The paladins of the development class system. We're a different breed and I'd be kind of suprised if a lot of WebDevs started shooting the place up. Well, maybe those fuckers who still use tables.
posted by Artw at 10:03 PM on March 21, 2010 [15 favorites]


So are all of the people complaining about the insurance mandate those same people who show up in the emergency room needing very expensive treatment because they've let some treatable condition get out of hand, and then go bankrupt sticking me and other premium payers with the bill?

Seriously, why shouldn't you be expect to carry health insurance when hospitals are legally required to treat you?
posted by betaray at 10:04 PM on March 21, 2010 [11 favorites]


So... Glenn Beck's show should e a big bucket of LOLZ tomorrow, right?
You misspelled "cocks."
posted by Threeway Handshake at 10:05 PM on March 21, 2010 [18 favorites]


dw that IRS worker was proven to had committed suicide. He just staged it like a murder for the insurance money.
posted by Allan Gordon at 10:07 PM on March 21, 2010


Allan, I think you're confusing dw's reference to the IRS employee who died in the plane incident with the census worker's suicide.
posted by MegoSteve at 10:10 PM on March 21, 2010 [1 favorite]


And here is exactly where they are heading: From Red State:

Ladies and Gentlemen, I submit to you again that it is not enough to just throw out the Democrats in favor of Republicans. We must throw out the Democrats and replace them with the right kind of Republicans — conservatives who actually are conservative. And then we must insist that these newly elected Republicans not settle for the status quo in leadership. What is now need not be left in place.

Already we have a few Republicans positioning themselves in grand theatrics to call for full repeal of Obamacare. But these same Republicans in the past have talked about the good parts of the bill and how repeal should be measured. The only way to ensure today’s rhetoric turns into future consistent actions is to surround these Republicans with true conservative warriors.

Friends, if we are going to destroy the Democrats, we must first build up an army of real conservatives in Congress. Half measures, Democrat-lite, and men who compromise in favor of more government must be unacceptable.

Let me be blunt: any Republican who says we will repeal and replace will themselves be replaced. We want repeal period.

This is not to say we will not offer up our own ideas, of which there are many. This is to say that right now there is no consensus on what to replace this monstrosity with, so instead of nuancing just promise to repeal it. We don’t need cute and clever politicians right now, we need a commitment to repeal Obamacare.


That's right Gottdammerung. They are running on complete repeal without telling America what they would do in place of the Democratic plan. This is a losing proposition.

The entire battle for this legislation hasn't been about healthcare at all. Its about an internal struggle in the GOP itself, where the conservative wing wants to dominate despite being anethema to the voters. This year will decide the GOP's fate.
posted by Ironmouth at 10:13 PM on March 21, 2010 [6 favorites]


What interestes me is how many of the recent spate of crazy anti-tax lunatics going off on one have been software engineers.

For some reason, engineering of all sorts is and always has been very popular with far-right conservatives and very religious Christians.
posted by Threeway Handshake at 10:13 PM on March 21, 2010


Another voice in the Happy-we're-finally-doing-something crowd. We know the bill's not perfect, but tomorrow looks a hell of a lot brighter than yesterday for a whole lot of people in this country. Why be the guy to look at that and say "Stop being glad that things are better"?
posted by krakedhalo at 10:13 PM on March 21, 2010


Oh right right right.

My bad.

I just wish that we could have all sit down at the table and tried to do something constructive. But of course the Republicans have taken the easy way out and yelled about death panels and other inane things to try to stop this from passing.

And now the idiots of their party have taken this to heart and will probably do some violence before all is said and done. Even though this bill would probably help them. Well guess that's the price of freedom of speech.
posted by Allan Gordon at 10:18 PM on March 21, 2010 [1 favorite]


In 1998, Peterson gained attention by proposing a constitutional amendment that would allow the residents of Minnesota's Northwest Angle to vote on whether they wanted to secede from the United States and join the Canadian province of Manitoba.

Mike Ross

Wut?

I had to come back just because right before I was going to go to bed you dropped three links.

The above is what I got from them.

Crazy.

Crazy.

WTF?

Seriously. This is your argument?

I was right. Bedtime.
posted by Splunge at 10:19 PM on March 21, 2010


More fun from Free Republic:

Gallup: Obama Up 3 points. Approval Now Stands at 50% [Americans That Moronic?]
March 21, 2010

Posted on Monday, March 22, 2010 1:13:00 AM by Steelfish

Gallup Daily: Obama Job Approval Obama Up 3 points. Approval Now Stands at 50% Each result is based on a three-day rolling average

Gallup tracks daily the percentage of Americans who approve or disapprove of the job Barack Obama is doing as president.


You can bet his numbers are going to climb now.
posted by Ironmouth at 10:21 PM on March 21, 2010


I get where Joe and Pope are coming from. I don't like parts of this bill. It helps companies I don't want to see helped. It will let a lot of people do fucked-up things. And, in all likeliness, these fucked-up things won't be instantly seen to. We haven't seen a revolution in a long time and we won't see one now. Things won't get magically perfect.

But that's how it works.

Shit is fucked. We're an experiment of a country with all sorts of insanities and faults. Things don't go right and we all hate it and it makes no sense. There's not a good quiet stable place in the whole country, particularly the political system. But that's a part of the experiment. The idea is that we progress very, very slowly, but we progress. Two steps forward and one step back.

This isn't everything I wanted. But it does more good then harm. It sets up a base for going ahead. It bolsters the guys who are more good guys than the other guys are. (That is to say, they're not very good, but let's be honest they're all we have at the moment.) It might lead to more good things.

We can be critical of it, we should be critical of it, but honestly sometimes we need to stop and say, Hey, things are better tonight than they were last night. Right now I should be happier than I am disappointed.
posted by Rory Marinich at 10:21 PM on March 21, 2010 [7 favorites]


Congratulations, Joe Beese / Pope Guilty! You just won the election for President of the United States of America! You now have a window of about one year to get the signature plank of your platform, healthcare reform, enacted. Something that has eluded every President since Teddy. You have been promised total opposition from the Republican party, who control enough seats in the Senate to ensure a filibuster. In addition, your own party is comprised of a loose coalition of liberals, social conservatives, and fiscal conservatives, and one of the most important members of you coalition in the Senate is pretty much paid for by the insurance industry and is not technically a Democrat. You also have in opposition the entire pharmaceutical industry, insurance industry (both of whom are arguably more powerful than the Federal government), and large swaths of the medical establishment, not to mention a right-leaning mainstream news media, including an entire 24-hour news network dedicated to making sure you fail. What do you do? You make the call!
posted by dirigibleman at 10:22 PM on March 21, 2010 [112 favorites]


Glad to see this passed.

I'm a pinko liberal who enjoys hobbies that are typically the bastion of uber-conservatives, so my facebook right now is filled with right-wing lunacy. Fun times.
posted by maxwelton at 10:23 PM on March 21, 2010 [1 favorite]


You misspelled "cocks."

No, I was perfectly accurate. He is a bucket of cocks. But occasionally his show is hilarious.
posted by sparkletone at 10:23 PM on March 21, 2010


Good riddance, you bloated junky.
posted by Blazecock Pileon at 10:26 PM on March 21, 2010 [6 favorites]


For some reason, engineering of all sorts is and always has been very popular with far-right conservatives and very religious Christians.

"Engineering is the art of organizing and directing men and controlling the forces and materials of nature for the benefit of the human race." -Henry G. Stott
posted by The Hamms Bear at 10:26 PM on March 21, 2010


First, let it be noted that the Senate bill passed by the House tonight becomes law as soon as Obama signs it. The reconciliation package headed for the Senate is its own bill. Regardless of what happens in the Senate, healthcare reform is pretty much a done deal.

Now, I'm looking over this nifty NY Times infographic outlining the changes the reconciliation bill will enact once the Senate passes it. These are the major changes I see: Over the next week or so as the reconciliation fight in the Senate plays out, keep in mind that this is what the Republicans are opposing. The core bill has already passed both houses and will be signed into law Tuesday. When Senate Republicans propose endless amendments and pull out every procedural trick in the book to derail and delay passage of this bill, this is what they're standing in the way of. Ending the backroom deals they complained about. Relieving the states of some of those unfunded mandates. Delaying and reducing taxes and expanding coverage while also saving money. These changes are what they're trying to kill now.

This fact should be noted -- repeatedly -- until the bill passes.
posted by Rhaomi at 10:26 PM on March 21, 2010 [31 favorites]


Blazecock Pileon: "Good riddance, you bloated junky."

You mean't bloated backpedaling scumbag fuckwad.

Please don't insult drug addicts that way. Junkys can get help. Limbaugh is beyond help.
posted by Splunge at 10:31 PM on March 21, 2010 [3 favorites]


In this instance, the legislative path was even more convoluted. Basically the house passed their version, then the senate passed theirs. They were different. But if they did the regular confrence committee thing, the new version of the bill could be filibustered, but because the democrats now only had 59 votes, rather then 60, they couldn't overcome it.

So, what they decided to do was have the house pass the senate version as is but then pass what they called a "sidecar" bill that would modify the bill they just passed, just like you can modify any bill that's ever been passed.

And the idea is, all of the items in the "sidecar" would qualify for reconciliation because everything in the "sidecar" would be directly related to the government's budget.


Oh. So American politics is like playing Magic: The Gathering with a really nasty blue deck. That's pretty sweet actually.
posted by Telf at 10:32 PM on March 21, 2010 [13 favorites]


I just keep replaying that Waterloo video and smiling. I'm a happy American, at least for this moment.
posted by wv kay in ga at 10:33 PM on March 21, 2010


I'm just thrilled that when my little sister graduates in two months she won't lose her insurance through my parents. It's such a weight off my mind. Thank you so much, America. This isn't everything I wanted, but it's more than I dared to truly hope for.
posted by little light-giver at 10:34 PM on March 21, 2010 [5 favorites]


On the one hand: yay! On the other hand: I still can't afford health insurance.
posted by effwerd at 10:35 PM on March 21, 2010 [7 favorites]


30 million new customers plus billions in federal subsidies...this is a bailout for the insurance industry which has been losing customers in the face of ballooning costs.

And keeps 'em solvent in the face of the collapse in commercial real estate that insurance firms tend to be 'invested' in.

Yet another bail out for the monied interests.
posted by rough ashlar at 10:35 PM on March 21, 2010 [1 favorite]


That's right Gottdammerung. They are running on complete repeal without telling America what they would do in place of the Democratic plan.

Yea... the Republicans had a clear playing field to do something with health care for many years. Any talk whatsoever by the GOP about "replace" is hallow talk.

It is interesting though, some of the quoted rhetoric, say this part:

Ladies and Gentlemen, I submit to you again that it is not enough to just throw out the Democrats in favor of Republicans. We must throw out the Democrats and replace them with the right kind of Republicans — conservatives who actually are conservative. And then we must insist that these newly elected Republicans not settle for the status quo in leadership. What is now need not be left in place.


If you switch out Democrats with Republicans (and visa versa) and progressive for conservative, you have exactly what many Democrats have been saying as well.

The problem is, and this is a big problem, Congress is, by and large, run by human beings and many of them are pretty ordinary people. Even if you replace all 535 members of congress overnight I'd wager my entire next paycheck you would not have behavior any different, in fact it is possible the behavior would be even worse. Redstate (and others) are deluding themselves that simply replacing congressional members would actually fix anything to do with the institution.

IMO a major part of the problem lies with the long term stability of the Republican party. They are reacting in a very panic orientated mode and when people act like that it causes problems for everyone. In a broad sense tonight the problem wasn't Stupak precisely, it was that the GOP is acting uniformly so constantly, that is pretty unnatural. The process prior to the current GOP crisis has generally been some give and take along the boarders. The Dems in normal times should have been able to let Stupak go and actually pick up a handful of R votes (like Cao for example). As much as they are a pain in the ass the Democrats are not the major broken problem right now. Consistent uniformity is a bad thing.
posted by edgeways at 10:35 PM on March 21, 2010


but it fails to address the underlying cost inflation. .... It was bullshit.

Yes. Considering inflation has been defined as the result of an expansion of the money supply - I'm not seeing how health care expands the money supply.
posted by rough ashlar at 10:38 PM on March 21, 2010


IMO a major part of the problem lies with the long term stability of the Republican party.

Exactly. Because Obama is running the action, people think he is the major aspect here. But there is a huge split about to happen in the GOP, as people start to realize that indeed, they just got their ass kicked. They will never repeal this. Ever. What other issues do they have? Incessant war? Pollution for all? They are down to nothing.
posted by Ironmouth at 10:42 PM on March 21, 2010 [2 favorites]


No more cheap insurance for those who stay healthy..... Expect to pay more unless you're already a corporate slave sucking the secure mammary of big biz.

Woot! Rather than dropping weight and trying to eat healthy I can load up on the farm-policy-cheap carbs!

ADM and Cargill exec are so happy.
posted by rough ashlar at 10:44 PM on March 21, 2010 [1 favorite]


I was skeptical. I started to sour on Obama and the Dems.

Maybe you did too.

But now that they've passed Health Care Reform -- even though without Single Payer or even a Public Option --, now that Dems, and only Dems with not one Republican vote have passed it, we have to support the Dems this election cycle.

Even though we know they're the lesser of two evils, even though they too are a Corporatist party, we have to strongly support the Dems this cycle.

Because if the Republicans make significant gains in November 2010, the Republicans will call that a "mandate" to repeal Health Care Reform. And they will repeal it, before Americans have a chance to experience it benefits, before American can realize it doesn't involve Death Panels or "takin' away" Social Security, or evil Commie-ism.

The Dems may be bastards, but they're our bastards now, and we can't let the Republicans get enough power to repeal Health Care Reform.

Whether gladly or holding our noses, we must unreservedly support the Dems in November 2010, with money, with volunteers, with votes. Maybe not every future cycle. But definitely this cycle.

Or we will watch from the sidelines as the Republicans and the Teabaggers strangle the baby Health Care Reform in its crib.

It's time to get to work.
posted by orthogonality at 10:45 PM on March 21, 2010 [80 favorites]


No more cheap insurance for those who stay healthy.

I am so tired of this sort of language. The kind that seems to assume that everyone who is sick must be sick because of some kind of moral failing. I am one of the many, the proud, the "pre-existing conditioned." I have an autoimmune disorder. When I was 12, my pancreas basically imploded, and I've been a Type 1 diabetic for most of my life. For many people, being one of "those who stay healthy" requires the occasional laying off the cheeseburgers, not smoking, and taking a decent number of walks. For me, it requires 24-hour-a-day monitoring of everything I do, everything I eat, how much exercise I've gotten, whether or not I'm stressed (and of course I'm stressed because I have to think about this every moment) and a million other factors, and if I don't I'll probably lose my sight or a limb or my life. It is HARD, and I am not a lazy insurance sponge, I'm spending most of my time just trying to maintain homeostasis while interning and writing my Master's thesis. And I have to listen to those 20-year-olds complaining that they don't want any health insurance because, you know, they're 20 and would never come down with the flu or get hit by a car like those icky sick people.

And the thing is, I grew up in Canada, and all through high school I never really gave this a second thought, because I knew I'd be okay. But the Ivies came a-calling, and now I'm almost through my second degree, and as soon as I finish, I'm sure as heck coming home, even though Canada still won't pay for my insulin unless I'm living in a hospital (or I'm really poor), which still makes no sense to me, as it is right up there with food and water with the things I need to live. But I've lived in the US for seven years (dual citizen) and even though I have school-sponsored insurance, I have never been able to lose that undercurrent of fear that tells me I'm one bad day away from ruin. Which, since all my conditions get worse with stress, really doesn't help things. As it is, I actually started running a temperature during some of the rebuttals after the first vote, I was so stressed.

I have mostly screamingly liberal friends (I'm in theatre, so ya think?) but I have gained a handful of conservatives in my life, and it's been both really surreal and really hard for me watching them oppose this bill (don't get me started on the diabetic I found who doesn't believe health care is a right. Natural selection, I guess). It just feels so personal, because it is. When I remind them that I'm one of those "pre-existing conditions" that would never get an insurance policy without a cushy job, they immediately say, oh, I wasn't talking about YOU. I'd help YOU. But who are they talking about, then? And why aren't they helping me by not opposing this bill? I kind of, in some small way, feel like Nice Gay Uncle Steve who is slowly helping to change the mind of his homophobic nephew, who says, "oh, well, except Steve." The disconnect is amazing. And so, even though it's flawed, this bill means everything to me. It means that America might consider me a human being worthy of saving, even if my pancreas doesn't.

In the end, it's not perfect, and I'm still leaving for greener pastures (icier tundra?) But there are so many who just don't have that option, and this is a start, and I am so happy. Tonight my boyfriend turned to me and said, "Yay! We might actually be able to live in America again someday!" and I think that's just about the right thing.

We might actually be able to live in America again, someday, everyone. That's something.
posted by ilana at 10:47 PM on March 21, 2010 [123 favorites]


American Health Care:

You're standing in front of a dam. There are many holes in it. Each hole has a spout of water coming out. Each spout of water turns a small water wheel. Each water wheel prints money.

The people that are supposed to plug the holes do not. Instead they look for more holes or actively poke more holes in the dam to place new water wheels to create more money.

A guy come along. He sees the tremendous amount of holes in the dam and notices that the dam has less water behind it than it used to have.

He says, You should fill some of the holes. Some people agree. Some don't.

One day he gets most of the people to agree to stop poking new holes in the dam. Perhaps he holds a gun to their heads. It doesn't matter.

Then he plugs a few holes.

Some water wheels stop. And they stop making money.

The people that own those water wheels get really pissed off.

But he says, "The water will eventually build up behind the dam. And then we all can use it.

The ones with the motionless wheels talk to the ones that still have wheels that move.

Do they decide to share the money that is produced?

We will see, kids.

We will see.
posted by Splunge at 10:52 PM on March 21, 2010 [10 favorites]


Malor wrote: "Our health care expenses are going to go UP from this, not down, but everyone was screaming that we needed this in order to contain costs. "

I think it's likely we'll see reduced increases for a short while once the mandate kicks in. The pool being larger should help reduce increases to any individual participant, anyway.

Basically, I think you're wrong that it's going to increase per capita costs any more than doing nothing would have. I do agree that it doesn't go nearly far enough in tackling the real problems, like why Medicare pays so much more in McAllen, TX than in El Paso.

The ____ of Justice wrote: "I don't know where you were during the recent mortgage industry bailout, but all right, I guess you're way more optimistic than I am."

It's much easier to pass little bills that fix what we've now got than it would have been to stuff it all into this bill and get it passed. We've got a while before the mandate kicks in. Let's see what the future holds.
posted by wierdo at 10:52 PM on March 21, 2010


I still don't understand how people cannot get that our economy will become stronger the more healthy people there are participating in it.

So yes in the worse case we may lose money with further health care reform, but the aggregate of having so many more people alive and healthy will probably outweigh it.

Also you know the whole idea of helping out your fellow man etc. Which is another reason why I was surprised that more religious organizations didn't get behind health care reform.
posted by Allan Gordon at 10:54 PM on March 21, 2010 [6 favorites]


Woot! Rather than dropping weight and trying to eat healthy I can load up on the farm-policy-cheap carbs! ADM and Cargill exec are so happy.

Wow. I didn't think anyone could get more cynical or idiotic than Pope Guilty and Beese. I stand corrected.
Maybe we should make a new flag for "Ego-driven masturbatory threadshitting."
posted by msalt at 11:02 PM on March 21, 2010 [2 favorites]


Fuck this. I'm going back to the other thread. They're having Manhattans.
posted by dirigibleman at 11:06 PM on March 21, 2010 [5 favorites]


We may actually start teaching people from a young age how to properly care for themselves.

Dr. - I'm gonna call bullshit.

Pres Kennnedy tried this with the vinyl record sent to the schools "go you chicken fat go" - the simple message of regular excersise was blown off.

but feel free to explain the ag policy of Butz, the ads for various foods WRT "proper care".
posted by rough ashlar at 11:06 PM on March 21, 2010


If it's true that the bill that just passed the House is very similar to the Republicans' proposal made during the Clinton healthcare debacle, what does that say about how far this country has shifted to the right since 1993?
posted by Napoleonic Terrier at 11:11 PM on March 21, 2010 [3 favorites]


UHC would be superior and the bill has flaws besides, but this is a good step forward. If nothing else, it reveals the complete and total incompetence of the Republican party as an opposition party. The Frum essay linked by crunchland is very amusing - the fact that the Republicans chose to stonewall rather than compromise now just makes them look like idiots, the whole lot of them.

The Tea Party also proves, once again, how dressing up in silly costumes and brandishing confused and/or offensive slogans affords you no credibility whatsoever and will, if anything, give you the exact opposite of what you want.
posted by Sticherbeast at 11:12 PM on March 21, 2010


I still don't understand how people cannot get that our economy will become stronger the more healthy people there are participating in it.

Feel free to explain how insurance == health.

Cuz on my overweight, crappy diet planet health is a function of what goes into the body combined with actual excersize and polluted environment.

Now - the other thread - they are having Manhattans and showing how the liver is evil and must be punished.
posted by rough ashlar at 11:13 PM on March 21, 2010


The Republican proposals during the clinton healthcare push was just a tactic to mess with the bill. Remember it was Newt who was leading the republicans at the time, they were not going to let the dems pass anything.

And they didn't and left Clinton looking like a jackass.

Since this HAS been passed rather than just talked about it's a huge shift. While some may bicker on if it's better for conservative or liberal values, there is no question that the dems have the momentum right now.
posted by Allan Gordon at 11:15 PM on March 21, 2010


Feel free to explain how insurance == health.

America can explain the ^insurance == ^health argument for you.
posted by Blazecock Pileon at 11:17 PM on March 21, 2010 [4 favorites]


I'll have to modify my state-of-the-union drinking game.
posted by fuq at 11:19 PM on March 21, 2010


While deductibles and lists of new taxes on tanning salons is nice, I think this bill should be summarized in terms of:

"I'm poor. I'm relatively healthy. I'm trying to find work when and where I can. I don't have health insurance. I can barely afford rent. What changes for me?"
posted by Avelwood at 11:21 PM on March 21, 2010 [1 favorite]


In the "cool infographics" department, nbergus' linked upthread to a NYT breakdown of the roll call vote that not only looks vastly superior and more useful than what our government produces, it also works for every rollcall vote for multiple sessions of Congress, just by parsing the URL.
posted by l33tpolicywonk at 11:23 PM on March 21, 2010 [1 favorite]


I'm not sure if anybody here has a solid link (with clearly delineated percentages and figures) to the specific graduated income scale related to the subsidies (i.e., the affordability credits). That is, the subsidies that partially cover the costs for the unemployed, self-employed, and those working for a business with less than 50 employees, all of whom will be obligated by law to individually purchase healthcare starting in 2014.

But here's one little aspect of the subsidies dug up by Jon Walker that greatly bothers me -- that indeed makes the establishment of a public option and a National Insurance Rate Authority for quality affordable healthcare essential. It looks like the affordability credits will stop in 2019. Which means that everyone described above could be forced to pay full price, without government help. (And if you don't purchase healthcare, you'll be hit with either a $695 fee or 2.5% of your household income, whichever is greater.) And if the affordability credits run out, and some unemployed guy with $500 in his checking account is asked to pay $7,000 in healthcare insurance costs or face the IRS, this is hardly what one might call progressive.

While I view this bill as a victory (with serious caveats), it's important to consider these long-term ramifications.
posted by ed at 11:23 PM on March 21, 2010 [3 favorites]


After having a look at some of the details on this, while they prevent insurers from dropping people who are costing them too much, is there anything to prevent them just increasing their premium until it is unpayable? You would think something like that would have to be included, but I didn't see anything in the few summaries I read.

Still, well done America, it's a start.
posted by markr at 11:25 PM on March 21, 2010 [1 favorite]


Let's face it people, this bill isn't perfect.

But look at the opposition. As Frum points out in crunchland's link (good to see you again cl), the GOP could have approached HCR ready to negotiate in good faith. Instead, they decided to play political football. "If we’re able to stop Obama on this it will be his Waterloo. It will break him."

I was shocked when DeMint said that. People are dying because of how the system is set up now--for fuck's sake, just a few days ago we had a thread about some poor kid with HIV being dropped from the insurance that he paid for--and they want to "break" him? This is serious shit, and the GOP is treating it like a fucking game. They had a decade to do something about healthcare--we've been talking about healthcare here at MeFi for years now--and they didn't do a damn thing to stop even half of the industry abuses that will be stopped by this bill within the year.

I shouldn't have been surprised by DeMint's comments, I guess. They want Obama to fail. These are people who are so cynical, they're playing the same playbook they played in 1994: spreading misinformation and scaring people (sometimes even with the same people they used back then).

Meanwhile, Obama and the Democrats are actually getting something done. Is it perfect? No. But they got everyone to sign on: the AMA, the unions, the healthcare industry, pro-choice congressmen, liberal congressmen, even Harry and Louise. Everyone but the folks who think this is the first step to a socialist takeover. This is why I voted for them. This is exactly what Obama said he would do.

In his address just now, the President pointed out that the work's not done. I'm with orthgonality. We can't sit on the sidelines right now.
posted by joedan at 11:28 PM on March 21, 2010 [24 favorites]


Remember when people used to chastise progressives for being too idealistic by saying "the perfect is the enemy of the good"? We've moved so far to the right that people are now saying the good is the enemy of the not-entirely-bad. There are actually people in this thread who are scolding those who are disappointed that we couldn't do better, encouraging them to applaud this enervating legislation because it upsets the teabaggers, and because there is a mote of progress here and there represented in the bill.

Here's the thing. If you want to be happy about this, knock yourself out. But I urge you to stop acting as though we should all celebrate because "this is the best we can get right now", as if political reality in a dynamic democracy was restricted to whatever the lame, cynical, popular media says is possible. If this is genuinely meant to be a step in the right direction, that means that those of you who are heralding this bill's passage a triumph need to set your standards higher, not that the people who are disappointed need to set their standards lower.
posted by millions at 11:29 PM on March 21, 2010 [16 favorites]


You know what would get me off?

Osama Bin Laden in chains heading to a federal courtroom.

You see, now we have full October Surprise capabilities. Imagine the titanic blow of the oval office photos--Obama giving the go order on the phone. A shattering blow to the GOP.
posted by Ironmouth at 11:31 PM on March 21, 2010 [1 favorite]


No insult meant, but I believe what Pope Guilty said here is wrong. This was one of my initial objections to the bill as well:
Yeah, it's going to be great when poor people have to buy insurance plans with huge deductibles that they can't afford to actually use.
They do not have to purchase such plans. Knowing as many underemployed people as I do, this sounded losy to me. But, in fact:
Although most Americans who do not obtain health insurance will face a federal penalty starting in 2014, many experts question how strict the enforcement of that penalty will actually be.

The first year, consumers who do not have insurance will owe $95, or 1 percent of income, whichever is greater. But the penalty will subsequently rise, reaching $695, or 2 percent of income.
Meanwhile, Medicaid is available for everyone earning below 133% of the poverty line, and significant plan subsidies kick in from 133-400%, with pressure on employers to provide equivalent plans. Where's the beef?

I'm about as lefty as they come, but this is a win even though I'm not satisfied.
posted by zvs at 11:32 PM on March 21, 2010 [3 favorites]


Hey, millions, when was the last time a bill was passed that you supported 100%?

Something that was perfect for you and wasn't just another step in the wrong direction.

Please tell us how to do it right since you obviously know so much more than the rest of us.
posted by Allan Gordon at 11:33 PM on March 21, 2010


Sorry, here's the cite.

Also:
Families that fall below the income-tax filing thresholds will not owe anything.
posted by zvs at 11:34 PM on March 21, 2010 [2 favorites]


ed: I missed your comment on preview. The affordability subsidies phase out concurrently with the introduction of exchanges where such plans can (hopefully) be purchased cheaply.
posted by zvs at 11:36 PM on March 21, 2010


Reproductive rights also include the right to OB/GYN care, prenatal care, the right to have children because you haven't been bankrupted by medical bills, the right to get STD tests, the right to get birth control pills, the right to get your endometriosis or PCOS treated before you lose your fertility (or in order to regain your fertility), and so on.
posted by internet fraud detective squad, station number 9 at 11:37 PM on March 21, 2010 [9 favorites]


I was one of those really healthy people who could've gotten really cheap health insurance. Then I got pneumonia and valley fever out of the blue. Suddenly, I'm in the hospital with over $10,000 in expenses. Now, so far as health care goes, that's cheap, but it's also almost as much as I made in a year then. If I didn't have health insurance, one night in a hospital would've destroyed my credit and maybe(?) even bankrupted me.

Now I apparently have asthma, but it goes untreated because my insurance policy doesn't cover prescription medications. I'd have to pay a lot of money to be able to exercise or laugh without coughing.

I don't think this bill helps me in any direct way. I'm not seeing anyone say the bill will give lower-cost asthma medication to people named 'Ms. Saint.' But, still, I'm so very happy. I'm so very relieved I don't have to worry about any future pre-existing conditions. I'm so happy that the number of people who stand to be bankrupted by a single night of medical care has decreased, at least a little bit.
posted by Ms. Saint at 11:40 PM on March 21, 2010 [2 favorites]


The uninsured poor still get sick and are likely to go untreated until a costly emergency room visit or, even worse, an expensive fight against a life threatening disease. Who do you think pays for that? I would personally rather foot the bill for someone to reverse their pre-diabetes symptoms before they end up in the ER getting their foot amputated. Better health outcome and cheaper. High fives.

I'm not happy about no public option and the blow to pro-choice but, fuck me, I'm still thrilled.
posted by Foam Pants at 11:41 PM on March 21, 2010


I'm sure anyone with a preexisting condition would agree with me.

Not me. Without a public option and some way to control Rx prices I expect to pay more.
posted by BrotherCaine at 11:58 PM on March 21, 2010


It's to bad the president didn't use his green lantern powers and will a perfect bill into existence, but it's a pretty damn impressive success of political comprise in a dysfunctional political system.

Also Nancy pelosi is the greatest liberal legislator of the past 50 years. The fact that she gets no respect says a lot about the latent sexism in America.
posted by afu at 12:14 AM on March 22, 2010 [14 favorites]


Memo to all those who complain that this bill is far from perfect:

"Laws are like sausages: it's better to ignore how they are made." Otto von Bismarck

By a curious coincidence, Bismarck was also the archconservative German chancellor who introduced the first mandatory health insurance program in the world. Welcome to the XIX century, United States of America.
posted by Skeptic at 12:15 AM on March 22, 2010 [7 favorites]


"It's to bad the president didn't use his green lantern powers"

It's too bad the President fought against the public option and and dropped single payer on the floor before anything started. He didn't need to be a superhero to support either of those. And since not a single Republican voted for the bill, he sucked up to them for nothing.

I'm happy because the teabaggers lost - but it's not that this bill is just "far from perfect" - this bill doesn't fix the main problem, which is that over a third of our health dollars are pissed away to the insurance companies. And I frankly believe the insurance companies will subvert it - if they claim that $30K a year is "reasonable" to cover my pre-existing condition, what recourse do I have?

I pray this works. Good luck, America.
posted by lupus_yonderboy at 12:25 AM on March 22, 2010 [7 favorites]


The most shocking thing I learned from this thread (way up near the top): Richard Nixon supported (some version of) universal health care. Now, it wasn't great, it wasn't necessarily what I would want, but it was something.

I had to let that sink in for a minute. Richard Nixon.
Had a plan for universal coverage.

Richard Nixon? Seriously?

So you're telling me that modern day Republicans and the teabagger protesters are less forward-thinking, less humane, less caring about their fellow citizens, the poor, the unemployed than RICHARD. FUCKING. NIXON.

Think about that. The modern right-wing is worse than Nixon.

That is fucking insane.
posted by Saxon Kane at 12:27 AM on March 22, 2010 [38 favorites]


Richard Nixon wasn't a horrible president.

He was however a horrible person.
posted by Allan Gordon at 12:31 AM on March 22, 2010 [34 favorites]


The modern right-wing is worse than Nixon.

It really is amazing that modern-day Republicans can stoop lower than Nixon. He also put together the EPA that eventually lead Superfund cleanups. The EPA had to be made toothless by George W. Bush.

It's pretty breathtaking what kind of disgusting human beings that conservatives have made themselves since the days of Nixon.
posted by Blazecock Pileon at 12:33 AM on March 22, 2010 [5 favorites]


Cradle-to-grave access to health care should be the right of every mammal on this planet. Probably reptiles, too, but they don't vote, so fuck 'em.

This is a significant step in the right direction, and I fucking dare future states-righters to walk it back. We're finally on our way to being a first-world country! USA! USA! USA!
posted by BitterOldPunk at 12:37 AM on March 22, 2010 [1 favorite]


Those children in the Republican Party have gone so far off the deep end that it makes David Frum seem like a reasonable person in comparison. What a world.
posted by i_have_a_computer at 12:43 AM on March 22, 2010


The senators who began giving speeches opposing abortion as violating the sancitity of human life are the biggest of hypocrites. How were these people able to vote to send our soldiers to die in Iraq, in a war that was based on lies and fabrications?
posted by reenum at 8:09 PM on March 21


<rant>

I'm thinking that a lot of these people are the same types who go on cable news shows and spout "support our troops" like they learned the phrase phonetically and never actually parsed the words.

Where instead of actually meaning something like

"Hey, we should make sure our young men and women have proper body armor, plating for their vehicles..."

in their bizarro-world mind it means

"Questioning or criticizing the legitimacy of the war is criticizing the troops."

Like somehow keeping our soldiers in the meat-grinder of a seven-year-mistake is preferable to bringing them home—the suggestion an "affront" that I imagine these people would counter with

"To bring those soldiers home now would be just the same as calling them pussies who can't win a war that was based on lies and fabrications. And I will not insult them thusly—no siree!"

The hollow spouting of "support our troops" seems the perfect tool for any preening jingoist politician—in a world where expressing concern for the wellbeing of soldiers is equated to the treasonous slandering of said soldiers, "support our troops" is a quick sound-bite-able tagline that costs them exactly nothing (and helps keep their flag-pin looking extra shiny!).

Of course when "Support our troops" is followed with the unspoken "(by keeping them there to pay for our fuck-ups with their very lives)" it tends to cost the troops and their families a whole hell of a lot more.

</rant>
posted by blueberry at 12:46 AM on March 22, 2010 [6 favorites]


It's too bad the President fought against the public option and and dropped single payer on the floor before anything started. He didn't need to be a superhero to support either of those. And since not a single Republican voted for the bill, he sucked up to them for nothing.

Well I guess he could have just used a gun to kill Lieberman, Lincoln, Baucus, Nelson, Bayh and all the other senate conservadems, but baring that or similar action getting single payer passed in the US senate is on the same level of fiction as comic book heroes.
posted by afu at 12:46 AM on March 22, 2010 [3 favorites]


lupus_yonderboy: It's too bad the President fought against the public option and and dropped single payer on the floor before anything started. He didn't need to be a superhero to support either of those. And since not a single Republican voted for the bill, he sucked up to them for nothing.

President Obama told the House Progressive Caucus that he would pursue a public option after the bill is passed. If you watched FOX News, you would know that.
posted by joedan at 12:53 AM on March 22, 2010


In the 70's an Agricultural Secretary named Earl Butz changed the way we provided a safety net to farmers: he switched us from a system set up in the great depression where the government guaranteed a minimum total income for farmers to cover crop shortfalls to a system where if the market rate of a bushel of corn dipped below an agreed upon threshold, the government would chip in to make up the difference. In the first system, there's no incentive to grow more crops - growing too much increases supply, thus lowering demand, thus lowering income; if you'll get the same net income by growing the right amount of crops as too much, you might as well save the extra effort. However in the second system, you should grow far more than you can use, since you'll get paid the same amount per bushel regardless, and thus more bushels = more $.

Thus, Earl Butz started the flood of cheap corn in America, which has changed how we eat, which has changed an untold number of things. There's probably no conclusive way to say so, but the argument that cheap corn is a heavy hitter in America's current obesity epidemic is pretty persuasive, and if that's true, then Earl Butz's decision to pay a few cents per bushel rather than a few thousand dollars per farm has had enormous unforseen consequences which we are still feeling forty years later. Given that we're passing our health and budget problems onto our kids, its likely that its still going to be having effects forty years from now.

Why bring it corn in a discussion of health care? Because it illustrates a simple point that is easy to overlook. Policy matters. Even if its just a tiny loophole, it has real world consequences.

So:

1. This bill might be bad; it might be good. But don't say it doesn't matter. It might not be as big as you'd want it to be, it might have loopholes, but that doesn't mean it won't have huge effects. Let's say that just 400 unnecessary deaths in the next five years are prevented by the steps in this bill, which is a reasonable estimate given the number of people it will insure and the number of unnecessary deaths the current health care system allows to happen. If I remember correctly, Oskar Schindler saved around 400 people from the camps, and they had over 6,000 descendants. Maybe my numbers are off, and maybe it is tacky to invoke Oskar Schindler as an example, but my point is the same: small things get bigger over time, and that matters.

2. No one can claim to know what this means yet. It isn't even signed yet, for Christ's sake, much less implemented. I know this is an easy mistake to make in the time of the 24 hour news cycle, but we won't really know what this bill means for years. Maybe we'll have a good guess in a year. Maybe some of the programs will be obvious successes or failures soon enough. But policy matters in ways that can't be predicted in real time. Earl Butz had no way to know what dominoes would fall after he tipped over the first one. There was no reason to think at the time that guaranteeing a price on a bushel of corn would lead to a massive health crisis - but it just might have. So if you want to say "this makes me nervous, we should watch it closely" - well, good for you. That's how democracy is supposed to work - and more importantly, its the only way to guarantee that good policy is put into effect properly. But don't say "this is a disaster" or "this is great" yet. This isn't anything yet, and won't be until it's signed and enforced and the effects have been felt.
posted by Kiablokirk at 12:58 AM on March 22, 2010 [22 favorites]


It's too bad the President fought against the public option and and dropped single payer on the floor before anything started.

"How much do you want for this?"

"$30"

"I'll give you $2."

"$29."

"$2."

"$28."

"$2."

"$27."

"$2 -- You know what? Screw this, I'll just get it at the dollar store."

"$26?"
posted by dirigibleman at 1:01 AM on March 22, 2010 [6 favorites]



So you're telling me that modern day Republicans and the teabagger protesters are less forward-thinking, less humane, less caring about their fellow citizens, the poor, the unemployed than RICHARD. FUCKING. NIXON.

Think about that. The modern right-wing is worse than Nixon.

That is fucking insane.


Well, to be fair, universal health care vs. mandatory health insurance?

Based on the bill alone, you could also argue modern day Democrats are worse than Nixon.

Which is, well, much more fucking insane.
posted by The ____ of Justice at 1:05 AM on March 22, 2010 [11 favorites]


We've moved so far to the right that people are now saying the good is the enemy of the not-entirely-bad.

That's exactly why people are cheering this. After 8+ years, the impenetrable theocratic conservative noise machine narrative is being turned back. That's the victory tonight - not the text of the bill.
posted by scrowdid at 1:22 AM on March 22, 2010 [6 favorites]


Hey, millions, when was the last time a bill was passed that you supported 100%?

Something that was perfect for you and wasn't just another step in the wrong direction.

Please tell us how to do it right since you obviously know so much more than the rest of us.



Where do I begin, Allan Gordon? No one here is interested in the last bill which passed that I supported 100% because I never stated or implied my total support was the standard for good legislation. I also never suggested that any bill which isn't perfect for me is a step in the wrong direction. And that last bit, where you represent me as condescending ("know so much more than the rest of us") while positioning me as polemically against everyone else AND sarcastically imploring me to come up with a catch-all solution to some vague "it"... Dude, I'm not in this thing for scoring rhetorical points on the internet. If you really want to discuss my post you can tell me specifically where I'm out of line, but if you want to play "You Got Served" internet typing hero, do it with someone else.
posted by millions at 1:24 AM on March 22, 2010 [8 favorites]


What interestes me is how many of the recent spate of crazy anti-tax lunatics going off on one have been software engineers. We're like the new postal workers or something.

Eric Raymond. Need I say any more?

Actually, I do: one of the diseases of IT/engineering/similar disciplines seems to be a relentless over-estimation of our own worth. And we have in abundance people who, like a certain Austrian painter or a certain shitty Eastern European novelist/philosopher, can only explain their own inability to be billionaires swimming in hot and cold running chicks, with the peoples of the world hanging on our every word and though it were very life-stuff of the universe dripping from our lips, in terms of the monsterous, perverted conspracies of the untermenchen.
posted by rodgerd at 1:30 AM on March 22, 2010 [10 favorites]


"I'm poor. I'm relatively healthy. I'm trying to find work when and where I can. I don't have health insurance. I can barely afford rent. What changes for me?"

One thing that will help you, thanks to Senator Bernie Sanders' negotiations, is that there are 10 billion dollars in the bill that will promote the establishment of community health clinics all over the country where you and your family will be able to get primary healthcare, dental care, mental health services, and low-cost prescription drugs on a sliding scale, based on your ability/inability to pay.
posted by darkstar at 1:43 AM on March 22, 2010 [9 favorites]


So now that they have served their purpose (and failed) will Fox and the lobbying groups quietly drop support for the Teabaggers?
posted by PenDevil at 1:58 AM on March 22, 2010


I've been out of the country for a year and a half now. So just to get this straight -- Obama is now possesed by the demon spirit of Hitler and is killing old people, so secret sleeper cells of the Boston Tea Parties have been reactivated. But they've lost.

It's good that this isn't explained clearly here in Mali or people might consider Americans to be completely insane.
posted by iamck at 2:09 AM on March 22, 2010 [10 favorites]


Based on the bill alone, you could also argue modern day Democrats are worse than Nixon.

And Nixon didn't try to push charter schools at the expense of public education, he didn't preside over a massive transfer of taxpayer wealth to Wall Street, and the EPA was created on his watch. It doesn't mean Nixon was a good guy, but it does maybe mean we suck worse than we would like to believe.
posted by Karmadillo at 2:12 AM on March 22, 2010 [5 favorites]


So millions you can't name a recent bill that you like.

And yet you complain about this one?

Fair enough. Some people just see the glass empty and broken, and I guess decide never to buy a new one.
posted by Allan Gordon at 2:21 AM on March 22, 2010


Glass? What glass? All I see is a paper cup with Noboma Kool-Aid in it and its so full its overflowing, poisoning even the bullets that were in my gun that he took from me when he repealed the Second Amendment three years ago.
posted by Joey Michaels at 2:32 AM on March 22, 2010 [4 favorites]


edgeways: "Jesus Joe, sometimes I get the feeling Obama came and pissed in your corn flakes personally. ... Tell me something concrete to do along with the incessant bitching, tell me something to do other than get angry, because there is just too many things to be angry about and I'm tired of it."

Campaigning on a public option and no individual mandate and then delivering an individual mandate and no public option does lend one's cereal a certain tang. Especially when the stated support for a public option is exposed as a cynical lie. (Or was it a lie that he, with heavy heart, had to tell us for our own good? Really, I'd like to know.)

For the record, I don't care whether you get angry at now being required by federal law to write a check equal to a government-designated percentage of your annual income directly to anti-trust exempt, for-profit corporations. Hell, you can issue a coin to commemorate the occasion if you like. (The motto could be something about the merger of state and corporate power.)

But if you're looking for something concrete to do, you could start by recognizing that the worthlessness of the promised consumer protections without a strong regulatory agency isn't something I made up in order to have something to bitch about on MetaFilter as an expression of my personal bitterness. It's an actual, irremediable problem with the bill that its supporters seem to be actively ignoring in order to convince themselves that, whatever their other disappointments, it's still "better than nothing".

Shorter version: I disclaim responsibility for how badly fucked we are and/or how tired it makes you.
posted by Joe Beese at 2:58 AM on March 22, 2010 [2 favorites]


I'm having trouble getting excited about a bill that "fixes" a lack of ability to pay for insurance by demanding you pay for it at gunpoint.
posted by DU at 2:59 AM on March 22, 2010 [6 favorites]


We kind of stand here on our little mud island, looking west across the ocean with our mouths open at you guys. Mostly in admiration, sometimes in horror, sometimes in awe.

Anyway, my mouth is hanging open today for the bill; because you needed the bill; because of the fights and the rhetoric around the bill. Hanging. Open. Well done.

And when you see an Englishman with his mouth open, you should aim to fill it with Philly cheese steak.

Whatever the fuck *that* is.
posted by Jofus at 3:15 AM on March 22, 2010 [3 favorites]


Whether you like the bill or not, it's an impressive victory for Obama and the Democrats. Let's see if they can actually sell it though.
posted by Brandon Blatcher at 3:39 AM on March 22, 2010 [1 favorite]


Expect to pay more unless you're already a corporate slave sucking the secure mammary of big biz.

Ok lets analyze this for a moment. Lets presume you are uninsured because you cannot afford the 'free market' prices out there, so yes, presumably you will pay more than $0 for getting nothing.

Lets also presume that you did manage to pony up for a high cost single insured plan because you are self employed, Are you actually stating that you are going to pay more than the highest cost in the industry already?
posted by MrLint at 4:10 AM on March 22, 2010


So the morning after, I hope people are still feeling exalted and not too concerned about the impact this will have on reproductive rights. I'm off to work to start planning out which states are worth fighting for - there are at least 15 who are absolutely certain to take the Nelson/Stupak opt-out and bar all women from getting abortion coverage in their exchanges. Which means millions of women will lose coverage and there's little that can be done about it. And there are probably 35 states that are "battlegrounds" where pro-choice activists will have to spend millions of dollars campaigning and lots of time and energy fighting to make sure things don't get worse. This is time and money that is not going to providing care. It's also a way to guarantee that fire-and-brimstone crazies that often get elected to state legislatures on a single issue stay that way and continue to undermine good governance. Be prepared for lots of ugly fights about this for years.

The 2 check requirement is probably going to result in a net transfer of millions of dollars a year from pro-choice families to pro-life families, as one cross-subsidizes the health care of the other. It will also cause some people to drop coverage as the person making that decision either does not want to go through an additional unnecessary burden for herself or for someone else.

As these millions of women lose coverage for a procedure that 1/3 of all American women will undergo at some point in their life, we're going to see significant effects on abortion providers. Already suffering during the recession and constantly under attack from state legislatures, some will certainly shut down as their funding is compromised. These providers are often remarkable individuals who provide phenomenal care even when individuals can barely pay. It means that abortion funds will be even more strapped for cash and that money will have to be siphoned away from advocacy and towards direct services.

And of course the federal government continues to fund abstinence only education and Crisis Pregnancy Centers - groups that also get millions of funds at the state level. This funding is entirely one-sided and does not go questioned. Making matters worse, the Supreme Court may grant cert in McCullen v. Coakley today, which is likely going to lead to the Court striking down all state buffer zones in the name of free speech. Irresponsible and inaccurate claims by the GOP about federally funded abortions has riled up the pro-life fringe and there's going to be even more of an uptick in violence at clinics. Already the reports of violence during 40 Days of Life have been high and it's not fun to work with Doctors who need to file restraining orders on people who follow them home - especially in the light of Dr. Tiller's assassination. It's been a fun month already.

I'd have supported this bill as a good first step had it stuck with Capps. I'm not someone railing about the mandate (which is largely incoherent. After all, even a public option would force you to go to...private doctors! We need government doctors to keep costs down! The mandate is fine people. A public option is an ok idea but not the end-all of progressivism).

The impact on the provision of abortion care is far more problematic than people realize and will cost us incredibly. And whatever you do, don't give to Planned Parenthood or NARAL in response. PP's preventive work compromised its ability to stand up when abortion was under attack, as they stood to gain more than they lost. That's fine, but they can't take a leadership role on abortion when they have other interests that interfere. And NARAL? It's unclear that they think that any of this is a bad thing.
posted by allen.spaulding at 4:20 AM on March 22, 2010 [17 favorites]


Eating their own.
posted by zerobyproxy at 4:21 AM on March 22, 2010


I'm off to work to start planning out which states are worth fighting for...

Thank you!
posted by Brandon Blatcher at 4:25 AM on March 22, 2010 [2 favorites]


I've been wondering about this since the election. Republicans have opposed any type of expansion of the government's role in health care. Whenever the public has actually seen incremental moves towards a rational health care policy they've supported it. So by passing any type of reform, weak, strong, symbolic, or real, doesn't Obama gain a tremendous political advantage two or three years out? If the Republicans do what they say they'll do and fight a rear guard action against this bill, wouldn't being known as the party of no amplify the Democrats' advantage? Am I missing something?
posted by rdr at 4:31 AM on March 22, 2010 [1 favorite]


I'd dearly love to see some real socialism in this country if only so conservatives can stop complaining about the center-right party we call the Democrats.
posted by DU at 4:58 AM on March 22, 2010 [2 favorites]


The bill is essentially a payoff and bailout of the insurance industry, folks. It's plain as day if you're willing to open your eyes and see it. It mandates that an additional 30 million people sign up for health care or pay fines, provides little to nothing to control costs, and imposes extra taxes on medical device makers (WTF? Someone builds heart stents and has to pay additional taxes?) amongst others. Who makes out? Big healthcare and hospitals, who now will have a better chance of getting paid in lieu of having to send out bill collectors.

Sure, it includes coverage for pre-existing conditions, which is a huge plus, but we couldn't find a way to include that in something less than 2,700 pages worth of legislation?

Really?

For those calling this a huge victory for Obama, that is yet to be seen. Boiled down to its essence, this merely follows in the steps of the bank bailouts, automobile rescue and stimulus bill.
posted by tgrundke at 5:03 AM on March 22, 2010 [2 favorites]


Woot! Rather than dropping weight and trying to eat healthy I can load up on the farm-policy-cheap carbs!
posted by rough ashlar at 10:44 PM on March 2


Please try this experiment and let us know how it works out for you.
posted by Optimus Chyme at 5:07 AM on March 22, 2010 [5 favorites]


And when you see an Englishman with his mouth open, you should aim to fill it with Philly cheese steak.
Whatever the fuck *that* is.


Wiz wit'.
posted by one more dead town's last parade at 5:09 AM on March 22, 2010 [1 favorite]


I have mixed feelings about the bill, but I unconditionally love watching conservatives lose.

I wanted to be the first to throw Palin's "hopey changey" line back in her face, but I'm several hours too late for that.
posted by diogenes at 5:18 AM on March 22, 2010 [3 favorites]



So millions you can't name a recent bill that you like.

And yet you complain about this one?

Fair enough. Some people just see the glass empty and broken, and I guess decide never to buy a new one.


So. Allan Gordon. Here you go: H.R. 1388 seems cool, as far as I can tell.

Now I'd like to point out that:

1) your assumption was incorrect
2) as criteria for being able to legitimately criticize the health care bill, this business about whether or not one likes other bills, be they recent or not, with support that is 100% or "perfect" or limited to "like", is total nonsense and besides the point.
3) you have declined to address the actual (as opposed to imaginary) content of my original comment in any meaningful way, and
4) your metaphor about a broken glass is inaccurate and bizarre ("decide never to buy a new one"? I'm never going to support a new health care bill? What?), and doesn't reflect my position concerning this bill in any way I can discern.

I hope you don't think that no one will notice you're not even remotely engaging in honest dialectic here. Kudos for getting me to respond to flailing rhetoric though--I'm a little embarrassed after I said I wouldn't play that game.
posted by millions at 5:20 AM on March 22, 2010 [4 favorites]


PP's preventive work compromised its ability to stand up when abortion was under attack, as they stood to gain more than they lost.

Could you elaborate on this a little, allen.spaulding? I don't quite understand what you mean, but I'm interested to.
posted by threeants at 5:23 AM on March 22, 2010 [1 favorite]


So, any chance any of the HURF DURF UNCONSTITUTIONAL idiots might end up getting the supreme court to say they need to add a public option? Even though they're falling back on a strict literalist interpretation that nobody has followed in centuries?
posted by mccarty.tim at 5:27 AM on March 22, 2010


Those in this thread who would like to see real HCR should check out Alan Grayson's Medicare You Can Buy Into Act proposal.
posted by DU at 5:31 AM on March 22, 2010 [2 favorites]


Hey, Sarah! Now that the death panels are in play, maybe you should hustle over to Canada! We're coming to get Trig, after all!
posted by mccarty.tim at 5:32 AM on March 22, 2010


Alan Grayson's Medicare You Can Buy Into Act proposal.

Oh, I guess I could have linked to this too. (Not loading for me now, but presumably that will be fixed.)
posted by DU at 5:34 AM on March 22, 2010


Do people imagine that they were raised in an Hobbesian state of nature, and that what they have is theirs by virtue of their own endeavours and nothing else?

Basically, yes.

I was in Germany a few weeks ago and got to talking to an American ex-pat. He's retired Air Force, and we were discussing the proposed health care reform. His biggest talking point? He has health insurance for the rest of his life from his Air Force retirement, and he didn't want the uninsured "cutting in line". He was worried that his hard work that merited him this health coverage would somehow be debased because of poor people getting coverage.

I'm listening to my coworkers around me right now and they're livid. I just heard someone say that these "bastards" (our Representatives) should be executed because they went against the will of their constituents.
posted by backseatpilot at 5:40 AM on March 22, 2010 [9 favorites]


I love how giving people healthcare options is "totalitarian" while no knock searches and warrentless wiretapping is "security." What a fucked up world Republicans live in.
posted by Pollomacho at 5:43 AM on March 22, 2010 [40 favorites]


*Most people will be required to obtain health insurance coverage or pay a fine if they don't. Healthcare tax credits become available to help people with incomes up to 400 percent of poverty purchase coverage on the exchange.


WHAT. THE. FUCK.

My parents have a hard enough time keeping their fucking cars on the road. "Tax credits" is not the same thing as "The government will pay if you can't afford to buy health insurance".
posted by dunkadunc at 5:47 AM on March 22, 2010 [8 favorites]


Could you elaborate on this a little

Sorry. Planned Parenthood is a phenomenal organization and I respect them quite a bit. It's just a double mistake to believe that PP == abortions. Abortion care is only 3% of what Planned Parenthood does. The vast majority of their work is prevention, STD testing, education, and most prominently, birth control. The bill itself will go a long ways in helping people utilize these services although none of the money will go towards abortions.

Furthermore, it's not as though Planned Parenthood is the only abortion provider in this country. While its corporate structure makes it the largest, as an entity it still only performs about 20% of the abortions in this country (That number is fuzzy, but it's in the ballpark, Guttmacher would have the best info). The majority of abortions are performed by small, independent abortion care providers. Furthermore, PP clinics focus on early abortions - women with complications who need late-second or third-trimester abortions always go to independent providers (such as the late Dr. Tiller).

So that's the problem. The largest provider is a giant entity that performs a lot of services and only a few abortions. They have the most resources but also other concerns. They had other interests at stake which compromised their advocacy on abortion. That said, I work closely with them and think they do amazing work. They just can't act as the sole spokesorganization for the community - especially in situations like this.
posted by allen.spaulding at 5:49 AM on March 22, 2010 [8 favorites]


What a fucked up world Republicans live in.

A coworker of mine has a thing up on the wall where he highlighted two sentences as, I guess, especially expressing why "healthcare is not a right". The first one says that humans have a right to live their life as they want. The second one is that there is a long history of patients paying for medical care.

The really sad part is that this is the official opposition-to-HCR statement from the APA.
posted by DU at 5:52 AM on March 22, 2010


*Most people will be required to obtain health insurance coverage or pay a fine if they don't. Healthcare tax credits become available to help people with incomes up to 400 percent of poverty purchase coverage on the exchange.

The "fine" is tacked onto your tax bill. If you face the "fine" AND you qualify for the credits they negate each other (somewhat).
posted by Pollomacho at 6:01 AM on March 22, 2010


Roger Ebert twitters:
History is watching the Republican Party shrink in its rear-view mirror.
posted by octothorpe at 6:01 AM on March 22, 2010 [4 favorites]


Oh God. They're already making assassination remarks. Stay classy, right wing.
posted by mccarty.tim at 6:04 AM on March 22, 2010 [1 favorite]


Lefty here. I watched over ten hours of this yesterday, even though my doctor told me watching assholes rant and make shit up all day is probably bad for my blood pressure.

My impressions:

- The deception on the left was actually minimal, although not non-existent. The deception (and flat-out fucking lying) on the right was stupendous. Smugness and a lecturing tone were the order of the day on the right. If I heard one more member of the fucking-MINORITY-party say "this is not what the American people want" I would have thrown a shoe through my TV.

-John Boehner's "performance" was, quite possibly, the most cynical, calculating and laughable piece of political theater I've ever seen.

-Bart Stupak (who I have absolutely zero love for) actually manned-up for a few great minutes, and deserves credit for that.

This bill is a significant step forward. It isn't close to perfect, but it lays the foundation - and for that I am truly grateful. As orthogonality said above, now is the time to really back the democrats. They have made an effort (however weak you make think it's been) to uphold their end of the bargain. We now need to keep them in the majority and keep pushing them to improve on this start.
posted by Benny Andajetz at 6:07 AM on March 22, 2010 [8 favorites]


Fuck yeah.

All I have.
posted by fourcheesemac at 6:11 AM on March 22, 2010


but we couldn't find a way to include that in something less than 2,700 pages worth of legislation

Please don't do that. If have problems with the bill, that's fine and completely understandable. But if you're complaining about the page of the bill, that makes zero sense. It smacks of you not only NOT having looked at the PDF of the bill, but also the possibility that you've looked at the actual printed version of the bill (i.e. the PDF) and didn't realize that the text is significantly larger than your average printed page.

Even worse, it makes you sound foolish, because it sounds like you think there's a direct correlation between the size of something and whether it's useful. That's a sign of poor thinking. Infinite Jest is widely considered a masterpiece of literature, yet it's over 1,000 pages long (actual account varies by editions of course). So much for the length argument.

Hate the bill if you, but please, hate it on its merits or lack there of, not a minor point that has no bearing on the content and effects of the bill.
posted by Brandon Blatcher at 6:16 AM on March 22, 2010 [8 favorites]


Meanwhile, Fox News' website is framing it as an abortion bill. Great.
posted by mccarty.tim at 6:18 AM on March 22, 2010


I can't understand this bill. Can someone please explain to me what this bill will change for someone who is, say 33 years old, making $75k/yr salary, gets insurance through his employer, and isn't currently sick.
posted by Pastabagel at 6:21 AM on March 22, 2010 [1 favorite]


There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.

Someone please correct me if I'm wrong on that.
posted by mediareport at 6:24 AM on March 22, 2010 [4 favorites]


Can someone please explain to me what this bill will change for someone who is, say 33 years old, making $75k/yr salary, gets insurance through his employer, and isn't currently sick.

It will let the insurance companies raise your rates. Oh wait, you asked what it would change.
posted by DU at 6:25 AM on March 22, 2010 [1 favorite]


Thanks for the explanation, allen.spaulding. That makes a lot more sense to me now.
posted by threeants at 6:28 AM on March 22, 2010


tgrundke:The bill is essentially a payoff and bailout of the insurance industry, folks. It's plain as day if you're willing to open your eyes and see it.

Please show us where to look so we can open our eyes and see it.

provides little to nothing to control costs

You're also going to have to back this up because the CBO says the bill will reduce deficits by about $140 billion by 2019 and more in the next decade. Granted, they can't see the future, but you're going to have to point out where they are wrong.

For those calling this a huge victory for Obama, that is yet to be seen.

It also has yet to be seen whether this will be a giant boon for the insurance industry, so I'm not sure why you're willing to state that as being "plain as day."
posted by ekroh at 6:30 AM on March 22, 2010


Can someone please explain to me what this bill will change for someone who is, say 33 years old, making $75k/yr salary, gets insurance through his employer, and isn't currently sick.

It will let the insurance companies raise your rates. Oh wait, you asked what it would change


Please explain this statement. So before this, the insurance companies couldn't raise your rates? Because it was my understanding that one of the main problems was that they were raising rates too much already. So then how is this a change?

In all seriousness, there will be more competition, meaning lower rates.
posted by Ironmouth at 6:34 AM on March 22, 2010


So then how is this a change?

See my second sentence: Oh wait, you asked what it would change.

there will be more competition

With whom?
posted by DU at 6:37 AM on March 22, 2010


New Economic Perpsectives has a critique of what's wrong with this "reform" - it solidifies the central position of the ridiculously inefficient private insurers:

Very briefly, the most significant outcome of this legislation is the windfall gain for insurance companies—who will be able to tap the wages of the huge pool of nearly 50 million Americans who currently do not purchase health insurance. Since many of these are too poor to afford the premiums, the government will kick in hundreds of billions of dollars to line the pockets of health insurers. This legislation has nothing to do with improving health services for the currently underserved—it is all about increasing the insurance sector's share of the economy...

There is nothing in the deal that will significantly reduce health care costs. At best, it will simply shift more costs to employers and employees—higher premiums, higher deductibles, higher co-pays, and more exclusions forcing higher out-of-pocket expenses and personal bankruptcies.


The Agonist has a similar perspective:

This is a bill that the insurance industry, for-profit hospitals and pharmaceutical companies will accept. They're willing to accept it because without the sorts of "reforms" contained in this bill they will experience catastrophic failure and massive amounts of popular ill will in the not too distant future. That's why it's accurate to call this a preemptive bailout rather than reform.

At this point, the bill does not regulate insurance rates. It stipulates that you can't be denied coverage or limited in your use of insurance, but it does not regulate how much you'll pay for that coverage. It only says that you're required to purchase coverage. The end effect then is to entrench the current system so deeply that further reforms are unlikely to be successful...actual reform that is. Politicians may fiddle around the edges, but the system that delivers sub-optimal care at great cost is here to stay...

Never mind the happy talk about how people without coverage will soon be transported to a magical land of possessing health insurance. This bill privatizes the profits and socializes the losses, funneling tax dollars to insurance companies rather than using them to provide health care. Mr. Obama and his party have found a way to subsidize a value subtracting industry and do so on your dime, all while telling you that this is the best they can do and that it all comes from their great love for you, the peasants.

posted by mediareport at 6:38 AM on March 22, 2010 [9 favorites]


CBO says the bill will reduce deficits by about $140 billion by 2019

Um, reducing government deficits is a separate issue from keeping healthcare costs down. This bill will do very little, if anything, to reduce costs, because the things we actually need to reduce costs - the ability to negotiate lower drug prices, for just one obvious example - were taken off the table by Obama to please the big drug companies.
posted by mediareport at 6:40 AM on March 22, 2010 [3 favorites]


There's some serious bizarro world twists in the end of this debate.

Many Republicans are challenging the legitimacy of an Executive Order that reads like something that a Republican president would issue. It makes me wonder how many people actually remember G Dubs presidency, even members of his own party.

How do I even know what is parody anymore?
posted by jefeweiss at 6:44 AM on March 22, 2010 [1 favorite]


"Boo hoo hoo!"
posted by you just lost the game at 6:48 AM on March 22, 2010 [3 favorites]


reducing government deficits is a separate issue from keeping healthcare costs down

You're right. My brain has been trained to equate "costs" with "costs to the government," so we're talking about different things.
posted by ekroh at 6:49 AM on March 22, 2010


"Boo hoo hoo!"
posted by you just lost the game at 9:48 AM on March 22


eponysterical
posted by one more dead town's last parade at 6:53 AM on March 22, 2010


Let the panic begin.

I have a feeling that rate hikes will happen fast and furious just like they did in the credit card industry. Make your money while you can before laws go into effect.
Shitty.
posted by stormpooper at 6:55 AM on March 22, 2010 [2 favorites]


And ekroh, I'm not sure why you can't see that forcing 50 million healthy uninsured people to contribute to insurance companies' bottom lines is a massive boon to those insurers.
posted by mediareport at 6:55 AM on March 22, 2010 [1 favorite]


And ekroh, I'm not sure why you can't see that forcing 50 million healthy uninsured people to contribute to insurance companies' bottom lines is a massive boon to those insurers.

Wouldn't that also lead to lower rates? I mean, it can be both.
posted by (Arsenio) Hall and (Warren) Oates at 6:57 AM on March 22, 2010


From the "Boo hoo hoo!" link: "Longer wait times, fewer doctors, more bureaucracy, massive IRS expansion, explosive debt, the end of the Pax Americana, and global Armageddon."

That's quite a casual chain you have there.
posted by EarBucket at 6:58 AM on March 22, 2010


I mean, it can be both.

It could also be neither, if those uninsured can't afford insurance. You know, the underlying problem that hasn't been fixed?
posted by DU at 6:59 AM on March 22, 2010


It could also be neither, if those uninsured can't afford insurance. You know, the underlying problem that hasn't been fixed?

You keep saying that, but didn't it work in Massachusetts? I mean, isn't that what effectively became law - the Romney legislation? If you can point me to where this has been a failure in getting insurance to the uninsured in Mass, then that'd be great, because I do share concerns about the bill but you seem stuck on GRAR and short on facts, figures, numbers, so on.
posted by (Arsenio) Hall and (Warren) Oates at 7:04 AM on March 22, 2010


Wouldn't that also lead to lower rates?

Why would it lead to lower rates? Oh, right, the kind-heartedness of the private insurance industry, which will naturally lead it to reduce its rates now that it has a permanent market required by law.

I'm sorry, but there is absolutely no reason to believe the insurance companies will lower their rates.
posted by mediareport at 7:05 AM on March 22, 2010 [3 favorites]


Why would it lead to lower rates?

I guess because that's how insurance works? You increase the pool of insured and rates go down. This isn't just health insurance but all insurance. Yes, their profits might go up but rates will presumably go down. There will still be competition between insurers - for instance we are all forced to have auto insurance yet competition keeps rates low.
posted by (Arsenio) Hall and (Warren) Oates at 7:07 AM on March 22, 2010 [5 favorites]


There is a moment in the video of the Boner [sic] rant where the Speaker bangs the gavel and makes a statement that I think essentially summarizes this whole messy affair: [here at 4:00]

"Both sides would do well to remember the dignity of the House."
posted by Pollomacho at 7:09 AM on March 22, 2010 [2 favorites]


You know, it's illegal to drive a car in the UK without car insurance (I'm guessing it's the same in the US). You can get fined and/or your car taken away if you do. Yet, somehow, insurance companies fight to provide the cheapest insurance quotes to attract drivers rather than jacking up the prices because you have to have insurance.
posted by EndsOfInvention at 7:11 AM on March 22, 2010 [19 favorites]


EndsOfInvention and (Arsenio), I look forward with bated breath to the decreases in health insurance premiums we're going to see in the United States as a result of this "reform."

On 2nd thought, I'm going to keep my breath unbated.
posted by mediareport at 7:13 AM on March 22, 2010 [1 favorite]


Congratulations for the "victory" of greater federal government control over our lives. If this reform was really about medical care for the needy, a federal program could simply have been created to offer those not now insured, presently not on Medicare or state programs like Medicaid, a basic medical plan. They chose, rather, to get into everyone's healthcare business.

And what of all the wasted money for special deals that were made in order to get this bill passed. Honestly, I do not understand how anyone who claims to be a proponent of the needy is not the most offended when a dollar that could help a poor person is being squandered in some way.
posted by bigwoopdeedoo at 7:14 AM on March 22, 2010


If this reform was really about medical care for the needy, a federal program could simply have been created to offer those not now insured, presently not on Medicare or state programs like Medicaid, a basic medical plan.

Yeah. Republicans totally would have gotten behind a new single-payer plan for poor people. Uh-huh.
posted by EarBucket at 7:19 AM on March 22, 2010 [10 favorites]


Asked to sum up what was going through her mind hours before casting a vote for health care reform, [Rep. Gwen] Moore broke out into a dance, pumping her arms in the air and singing the Michael Jackson song "Thriller."
posted by EarBucket at 7:20 AM on March 22, 2010 [5 favorites]


OK, I feel so overwhelmed by the abundance of different (divergent?) opinions about the HCR that I'm a bit shy to mumble a sincere "Good, a step in the right direction!" from this side of the Atlantic :)
posted by fonso at 7:20 AM on March 22, 2010


National Review's server is down. I wanted to see their publicly funded Whaaambulence. The right wingers must be scared.
posted by mccarty.tim at 7:21 AM on March 22, 2010


I think I may have a crush on Gwen Moore after her speech in the debate and that little dance.
posted by mccarty.tim at 7:22 AM on March 22, 2010


Honestly, I do not understand how anyone who claims to be a proponent of the needy is not the most offended when a dollar that could help a poor person is being squandered in some way.
posted by bigwoopdeedoo at 7:14 AM on March 22 [+] [!]


Well, you are correct. No one really still gives a shit about the needy at a federal level. This bill was a step toward reducing the risk of catastrophic financial ruin for the average "non-needy" type, among other things.
posted by docpops at 7:26 AM on March 22, 2010 [2 favorites]


a federal program could simply have been created to offer those not now insured

I believe that would be called the "public option".
posted by gimonca at 7:27 AM on March 22, 2010


I guess because that's how insurance works?

Um...don't bet on it. And you can't compare to auto insurance. Where is the rise of cost in auto insurance? You will still have those who can't pay the hospital bill. You will still have the cost of healthcare technology. And I believe that no caps and no preexisting will be the perfect excuse to raise the cost back to the insured.

Cost savings was the goal. It was access.
posted by stormpooper at 7:28 AM on March 22, 2010


Did the provision about the percentage of premium payments required to go to patient care not make it through?
posted by dilettante at 7:32 AM on March 22, 2010


I guess because that's how insurance works?

Um...don't bet on it.


What? I'm not betting on anything. I'm stating that insurance works in a very particular way. A larger pool of customers will offset costs to those already enrolled. That's just, well, how it works.
posted by (Arsenio) Hall and (Warren) Oates at 7:32 AM on March 22, 2010 [2 favorites]


in my gun that he took from me when he repealed the Second Amendment three years ago.

Sure you havn't looked in the Bushes over there on the Right for where the gun was tossed aside?
posted by rough ashlar at 7:34 AM on March 22, 2010 [1 favorite]


Asked to sum up what was going through her mind hours before casting a vote for health care reform, [Rep. Gwen] Moore broke out into a dance, pumping her arms in the air and singing the Michael Jackson song "Thriller."

She was just practicing for the prison state that will exist under Obamunism.
posted by Pollomacho at 7:36 AM on March 22, 2010


It could also be neither, if those uninsured can't afford insurance. You know, the underlying problem that hasn't been fixed?


For those people who can't afford insurance and would otherwise be penalized, there are hardship waivers.
posted by anniecat at 7:36 AM on March 22, 2010


If I were a legislator my next step would be to look at the right and say:

"You're worried about the accounting here? You think we're not paying for this? We're about a trillion dollars short? Fine. I hereby introduce my bill to repeal G.W. Bush's tax cuts ( pushed through in reconciliation against "the will of the American public"), with resultant monies going to pay for this."

In my 50 years, it has become patently obvious that the right has exactly one argument when it comes to social programs: "We really are with you on this, but now is not the right time."

In a weak economy:"This will suppress the ability of "job creators" to "create jobs".

In a strong economy: "We can't afford to slam the brakes on this speeding train."

Molly Ivins said of G.W. Bush, " He was born on third base, and thinks he hit a triple." That, IMO, is the problem with a bunch of rich white guys preaching self-reliance and initiative. Most of these guys think they are where they are solely as a result of their own intelligence and hard work. That's the big lie. Hard work is part of it, but so is luck and timing. Dismiss it all you want, we all stand on the shoulders of the people who came before us.
posted by Benny Andajetz at 7:42 AM on March 22, 2010 [38 favorites]


For some reason, engineering of all sorts is and always has been very popular with far-right conservatives and very religious Christians.

Not just Christians; apparently a disproportionate number of Islamist militants are engineers by training.

Perhaps it's something about the nature of engineering as a mental discipline: the rigour of absolutes (figures, rules, no room for subjective nuance as in the humanities) combined with directly dealing with the concrete world (as opposed to theory, as physicists and mathematicians, for example, have the luxury of)?
posted by acb at 7:42 AM on March 22, 2010 [3 favorites]


Capitalism is all about winners and losers. As such, conservatives hate anything that makes it harder to tell the difference between the two groups. That, plus good ol' fashioned racism, is why they're freaking out over HCR.
posted by Stonewall Jackson at 7:42 AM on March 22, 2010 [17 favorites]


I'd dearly love to see some real socialism in this country if only so conservatives can stop complaining about the center-right party we call the Democrats.

Outside of the military-industrial complex and corporate welfare, you mean?
posted by acb at 7:43 AM on March 22, 2010 [1 favorite]


Hall and Oates. Wrong phrasing on my part. However, insurance works like that as a basic model. Healthcare isn't a basic model. There are way too many factors to influence it beyond more people = keeping cost down.

Anyway, it still is a great step in the right direction. But a 69% hike by BCBS CA was criminal and seeing that others are following suit, how is cost being controlled?
posted by stormpooper at 7:43 AM on March 22, 2010


The reality of American politics, and all politics, is that you fight as hard as you can and take what you can get along the way. Now on to regulating prices and getting a public option.

If you don't see this as a victory that transcends the actual bill, you aren't a realist.
posted by fourcheesemac at 7:44 AM on March 22, 2010 [8 favorites]


Cost is a different issue. I'm not even arguing that rates will go down - they certainly might. I am saying that the argument: "insurance companies are going to raise rates because 30 million new people are going to be insured" is incorrect. Adding all those people to the pool will drive down rates. Of course, in time, other factors may drive those rates up again.
posted by (Arsenio) Hall and (Warren) Oates at 7:47 AM on March 22, 2010


This came up in FB comments. Anyone want to take a stab at it?

"OK soo here is a guestion.. which is just simply tht.. under the HIPPA rules the third party payer of insurance has the right to see all of your health care information does this mean the goverment has this right to view them since they are the payer of the policy? EVEN with or w/o the patriot act.. just curious how all this goes now..a ... See Morend with most states.. anything tht is used or paid for in healthcare by the state once u become eligable for better insurance wht has been barrowed the goverment will come back and sue you for.. or sue the family for once deceased .. will this still apply??regardless of income?? "
posted by anastasiav at 7:51 AM on March 22, 2010


If you still want a pony, would a unicorn do? Did they pass health care reform?
posted by Benny Andajetz at 7:56 AM on March 22, 2010


We'll see. Hearing first hand the other side of the argument says a completely different thing. Powerpoint slides a plenty I'm sure. :)
posted by stormpooper at 7:58 AM on March 22, 2010


My congratulations to America for getting healthcare reform.

My condolences to America for what you actually got (or more accurately, didn't get).
posted by blue_beetle at 7:58 AM on March 22, 2010 [1 favorite]



From the "Boo hoo hoo!" link: "Longer wait times, fewer doctors, more bureaucracy, massive IRS expansion, explosive debt, the end of the Pax Americana, and global Armageddon."


Any global armageddon that so completely unhinges the already unhinged National Review, is Global Armageddon I can believe in.
posted by thivaia at 8:01 AM on March 22, 2010 [1 favorite]


So don't believe anyone who says Obama's health care legislation marks a swing of the pendulum back toward the Great Society and the New Deal. Obama's health bill is a very conservative piece of legislation, building on a Republican rather than a New Deal foundation. The New Deal foundation would have offered Medicare to all Americans or, at the very least, featured a public insurance option.

The significance of Obama's health legislation is more political than substantive. For the first time since Ronald Reagan told America government is the problem, Obama's health bill reasserts that government can provide a major solution. In political terms, that's a very big deal.
-- Robert Reich
posted by (Arsenio) Hall and (Warren) Oates at 8:02 AM on March 22, 2010 [5 favorites]


Some of the right wing blogs are saying that this starts a slippery slope to a single payer system, and the end of the HMO industry as we know it.

God, they're optimistic.
posted by mccarty.tim at 8:03 AM on March 22, 2010 [33 favorites]


Here's the thing. If you want to be happy about this, knock yourself out. But I urge you to stop acting as though we should all celebrate because "this is the best we can get right now",

What it is, is WAR, and a long one, and the reason to celebrate is that a battle has been won, arguably a pivotal one. But there will be more battles. It's that kind of war. The stakes are too high. Billions/trillions of dollars are on the line, not to mention an overall sea-change in ideology as to how Americans THINK of themselves (ie: maybe we really are a nation that takes care of our downtrodden). The notion that a single battle was ever going to "win" this thing shows a naive read of politics and history.

If this is genuinely meant to be a step in the right direction, that means that those of you who are heralding this bill's passage a triumph need to set your standards higher, not that the people who are disappointed need to set their standards lower.

In keeping with the WAR analogy, those heralding the bill's passage need to realize that this thing will be ongoing, a complex series of victories, stalemates, defeats, armistices, reconciliations etc that may well go on perhaps for generations. The hope is that slowly (inexorably perhaps) things will get better for pretty much everybody and everyday Americans will find themselves arguing/struggling about something else hopefully less pivotal.

Those that are disappointed need to grow up a bit, maybe a lot.
posted by philip-random at 8:06 AM on March 22, 2010 [5 favorites]


And ekroh, I'm not sure why you can't see that forcing 50 million healthy uninsured people to contribute to insurance companies' bottom lines is a massive boon to those insurers.

Because it's not the case that the bill forces 50 million healthy uninsured people to contribute to insurance companies' bottom lines. For one thing, estimates are that coverage will extend to 32 million uninsured people, not 50 million people. And they aren't healthy. A lot of them are the people who can't get insurance precisely because they aren't healthy and have preexisting conditions or the were dropped because they got sick. Those people definitely aren't good for an insurance company's bottom line.
posted by ekroh at 8:08 AM on March 22, 2010


And you can't compare to auto insurance. Where is the rise of cost in auto insurance?

One of the arguments against the universal requirement for auto insurance was that the insurance companies would keep jacking up rates once everyone was required to buy insurance. That happened a bit at first, but then it stopped, because cut-rate insurance companies like Geico started entering the market, which put pressure on State Farm and others to hold the line on rates.

And, of course, the one main difference between health insurance and auto insurance is depreciation. Eventually a $3000 repair bill exceeds the value of a car and the insurance companies totals the car. With most people, though, health costs get more expensive the older they get.

You will still have those who can't pay the hospital bill. You will still have the cost of healthcare technology. And I believe that no caps and no preexisting will be the perfect excuse to raise the cost back to the insured.

But isn't there a high risk pool in this bill? That would effectively allow you to tranche the high-risk people into a government subsidized group that's segregated from the young and very healthy. You may still need to raise rates on the healthy to cover the high risk pool, but it won't be as dramatic.
posted by dw at 8:08 AM on March 22, 2010


Of course, in time, other factors may drive those rates up again.

I'm guessing that among those factors will be:

1) insurance company greed; and

2) poor (even at times irrational) investment choices by insurance companies.

I'm gussing this will be blamed on:

1) Tort claims; and

2) Illegal aliens "burdening" the system.

How do I know? I'm frickin' Nostradamus.
posted by Pollomacho at 8:09 AM on March 22, 2010 [7 favorites]




If you lost your job, you can't get dinged for a preexisting condition (which they would work hard to find).

You can stay at your company and before you retire you rack up $1mill (or whatever your cap is) in med bills, you won't have to worry about running out of coverage.

Those, at least for me, are the 2 biggest hurdles. No Medicare donut hole, etc. are a big win too.

This is really a great turning point. I just wish they could have battled loopholes in coverage such as not covering hearing aids, infertility, etc. for the lamest of excuses. Those things will still happen.

posted by stormpooper at 8:11 AM on March 22, 2010


[Rep. Gwen] Moore broke out into a dance, pumping her arms in the air and singing the Michael Jackson song "Thriller."

I would love for our congresspeople to learn how to do the Thriller dance and have C-SPAN record it. Everybody, call your congresspeople and demand they learn how to do this dance!
posted by anniecat at 8:12 AM on March 22, 2010 [3 favorites]


I don't know what the answer is. The questions keep coming on. I want to know why a large sect of BCBS companies are raising rates. 68% is justified? Glad CA is fighting back.
posted by stormpooper at 8:12 AM on March 22, 2010


Here is an article from Atul Gawande in the New Yorker (no subscription required) about how the Senate bill could control costs. From the article:

"Pick up the Senate health-care bill—yes, all 2,074 pages—and leaf through it. Almost half of it is devoted to programs that would test various ways to curb costs and increase quality. The bill is a hodgepodge. And it should be."

I'm not saying it's an airtight argument that the bill will control costs, just saying that it's not as simple as saying the bill does nothing to control costs.
posted by ekroh at 8:17 AM on March 22, 2010 [4 favorites]


And what of all the wasted money for special deals that were made in order to get this bill passed. Honestly, I do not understand how anyone who claims to be a proponent of the needy is not the most offended when a dollar that could help a poor person is being squandered in some way.

Err,
Based on Thursday's changes, the health legislation also:

-Retains $300 million in extra Medicaid aid for Louisiana, which had helped win support for the Senate health bill from Sen. Mary Landrieu, D-La. The state is still struggling to recover from Hurricane Katrina.

-Keeps $100 million included in the Senate bill that is expected to go for a public hospital in Connecticut sought by Dodd, who is retiring.

-Preserves language won by Baucus permitting many of the 2,900 residents of Libby, Mont., to qualify for Medicare benefits. Some of them have asbestos-related diseases from a now-shuttered mine.

-Provides an additional $8.5 billion over the next decade for 11 states and the District of Columbia to help them pay for the more generous Medicaid assistance they have been providing low-income residents. These states are Arizona, Delaware, Hawaii, Maine, Massachusetts, Minnesota, New York, Pennsylvania, Vermont, Washington and Wisconsin.

-Maintains a Senate-approved provision giving extra money for hospitals and doctors in North and South Dakota, Montana and Wyoming.
And the infamous "Cornhusker Kickback" that the Senate will strip from the bill if they don't weasel out of passing the reconciliation package is extra Federal funding for Medicaid for Nebraska.
posted by dirigibleman at 8:19 AM on March 22, 2010 [1 favorite]


Some links to help make sense of it all:

From the White House: a step by step analysis, a summary of the bill, and links to the text of the bill and accompanying documents.

The Daily Beast gives some talking points, the Washington Post lists some talking points, and what each side of the debate hoped to get out of it

The Kaiser Foundation gives a rundown of the various proposals that were on the table.
posted by reenum at 8:21 AM on March 22, 2010 [7 favorites]


It may be 2,074 pages but

For some reason Congress formats like they're writing a paper on Romantic poetry and I think this 4 inch margin is really subtle, no one will notice if I triple space
posted by internet fraud detective squad, station number 9 at 8:21 AM on March 22, 2010 [6 favorites]


So, what are the chances of the GOP taking back the house and doing a repeal? Don't they not have enough money to do that?
posted by mccarty.tim at 8:23 AM on March 22, 2010


Vagina.

(trying to lighten the mood)
posted by stormpooper at 8:23 AM on March 22, 2010 [2 favorites]


dirigibleman, it looks like all that stuff is going to go to poor people. Just...conveniently located poor people.

I can't complain about New York getting more funding, we pump money into the federal government and relatively we get jack shit back.

Louisiana has a horrible standard of living, glad to see them getting some cash

Obnoxious, but at least they're getting health related pork instead of random $800 bottles of water
posted by internet fraud detective squad, station number 9 at 8:26 AM on March 22, 2010


MY VAGINA IS SERIOUS BUSINESS
posted by internet fraud detective squad, station number 9 at 8:26 AM on March 22, 2010 [2 favorites]


Oh right, they can't take back the House. Thanks, Steele. Between the GOP website and this, you're my favorite Republican!
posted by mccarty.tim at 8:27 AM on March 22, 2010 [1 favorite]


About the same as the GOP successfully repealing Social Security, which is slim to none.

I wonder though how much the potential costs of this bill will be deferred from the fact that we are already paying health-care costs for the uninsured and underinsured, through a system that's horribly abusive and inefficient. At least one of the things this bill potentially does right is mandate coverage for preventative medicine and provides incentives for more primary care.
posted by KirkJobSluder at 8:29 AM on March 22, 2010


Haha seriously Free Republic? Why are you right wingers always bailing out the postal system?
posted by mccarty.tim at 8:31 AM on March 22, 2010


Seeing the teabaggers melt down is nice, but doesn't change my core concerns about the bill, nor my doubts that we will get to improve it. This only slipped through because the Senate passed it before Brown got in, now that the Republicans have their solid and unchallengeable 41% majority in the Senate they can, and will, stop any future improvements, and I'm quite doubtful that the Democrats will be able to get back up to 60% anytime soon.

Still, it's fun seeing teabagger heads explode.

That said, the battle was lost, the side of corporatism/fascism has won, and all we can do is move on to fight harder for the public option that the Blue Dogs and Obama killed. Obviously we can't get it through the Senate, but we should make the attempt a regular occurrence. "Yet again the Blue Dogs and Republicans deny Americans the right to escape from corporate dominated health insurance...."

From an immediate tactics situation I don't see a lot of change, except that the movement to oust the Blue Dogs may have gained more support. Stupak, especially, has become a lightning rod for liberal/progressive hate, and with any luck we can, at the very least, force him out.

As for the rest, who knows. We lost bigtime to the corporate interests this time around, we lost bigtime to the forces of misogyny, we lost bigtime to the anti-sex league ($50 million a year for abstinence only miseducation).

I do think that the Republicans will take care of a several of the Blue Dogs for us. Those vile scum are mostly from Republican leaning states, and I don't think their votes against health care reform will save them from the rising tide of teabagger hatred. No one with a "D" in front of their name will survive in areas where the teabaggers have any influence at all, no matter how many hippies they punch.

So yay, I guess. The Blue Dogs hurt us badly, they made any "victory" here dirty and got in one last fuck you to women everywhere, and now they'll be dragged down by the people they tried to suck up to, there's a certain degree of poetic justice in that.

As for the rest, I remain hopeless that we will ever see a public option to allow us to escape from the evils of corporate insurance. With the new flood of money both from those forced by law to buy their worthless products and tax money to boot, I have no doubt that the health insurance industry will be able to bribe enough politicians to keep the public option forever out of reach. I think it may, like Roe for the Republicans, become the position that Democrats love to never win on, because it lets them try and fire up the base without actually giving them anything.

So onward to fight for a public option, and a big fuck you to Obama for cutting a deal with the hospitals to kill it. I'll vote for him, as always, because the alternative is worse, but I hope that we all remember that he betrayed us, he lied to us, and he can not be trusted. I thought I was cynical enough not to be suckered by a politician's empty promises, but Obama proved that I wasn't cynical enough. I genuinely thought he was kind of on our side here, that his campaign promises weren't just empty bullshit, and I was wrong. He suckered me, and I'm humiliated to admit that, but I will never be suckered by him again.

Still, we can and should fight on for incremental improvements, and while I remain steadfastly opposed to the new law on the grounds that forcing people to do business with evil insurance corporations is wrong, I can at least take vicious pleasure in watching the lamentations my enemies in the teabagging community. Maybe one day we can actually win something cleanly, without throwing women under the bus, without sucking up to the most vile and despicable elements of the government, and without giving away the whole game to corporations.

Meanwhile, now that this abomination has passed maybe we can get on with the fight for real and significant health care reform and pressure for the passage of a public option, rate controls, etc.

anastasiav My answer would be that thanks to the Patriot Act the FBI, CIA, etc already have access to your health info if they want it, and I really don't see how this makes any difference one way or another. I'd also imagine that it would be relatively simple to change HIPAA so that government payments don't count for that provision.
posted by sotonohito at 8:34 AM on March 22, 2010 [7 favorites]


Molly Ivins said of G.W. Bush, " He was born on third base, and thinks he hit a triple." That, IMO, is the problem with a bunch of rich white guys preaching self-reliance and initiative. Most of these guys think they are where they are solely as a result of their own intelligence and hard work. That's the big lie. Hard work is part of it, but so is luck and timing. Dismiss it all you want, we all stand on the shoulders of the people who came before us.

While I agree with the sentiment, this is the most confusing set of metaphors I've ever seen, short of when my high school history teacher told us 'You have to step up to the plate or you'll fall in the tank and have to dig your way out.'
posted by shakespeherian at 8:35 AM on March 22, 2010 [1 favorite]


This was a contest to see who could deliver better for the insurance/health care/drug industries. The democrats won and now get to bathe in unlimited campaign contributions this/next election cycle. What's next? - fresh from this victory over obviously deranged tea-baggers and us pathetically deluded liberals, he's gonna make his play against Social Security. Flame on.
posted by jake1 at 8:35 AM on March 22, 2010


So, what are the chances of the GOP taking back the house and doing a repeal? Don't they not have enough money to do that?

Slim-to-none, IMO. They are already seen as obstructionists by a large swath of sensible Republicans.

Filling the "donut-hole" on seniors' medication plans will prove to be a master stroke here. Republicans already skew older. They need the seniors; alot of them are scraping and will be loathe to give back this hand-up.
posted by Benny Andajetz at 8:37 AM on March 22, 2010


Thank you, reenum. Excellent links! :)
posted by zarq at 8:41 AM on March 22, 2010


There is nothing in the bill to regulate the rates insurance companies charge.

See...this is what I just don't understand about politics and political strategy. If I were a Republican strategist and really, truly, honestly wanted to kill this bill, this is the point I would have pushed constantly at the American public. I would have gone straight at their pocketbooks, and at the problem they deal with on a daily basis. Namely, the cost of healthcare and insurance. I would make sure that talking point #1 is that this bill does nothing to lower the average family's insurance bills. It does nothing to lower the cost of employer-provided plans. It does nothing to control costs on the provider side of the equation.

Instead, they decided to go into this "OMG teh socialism!!!" mode, and ended-up looking like fucking loons. I just don't understand it.
posted by Thorzdad at 8:49 AM on March 22, 2010 [3 favorites]


If I were a Republican strategist and really, truly, honestly wanted to kill this bill, this is the point I would have pushed constantly at the American public.

Two problems with that:
1. It's a complex explanation when something simple like "SOCIALISM!" is simpler and more emotional

2. The GOP is in the pocket of the insurance companies. The last thing they want to do is even appear to be throwing the insurance companies in front of the bus.
posted by dw at 8:52 AM on March 22, 2010


Fair enough. Some people just see the glass empty and broken

When the glass is actually empty and broken these are the reasonable people. Other people insist on trying to drink from it, remarking one to another how cool and refreshing it is, while actually they're just stabbing themselves in the face with broken glass again and again.
posted by enn at 8:53 AM on March 22, 2010 [10 favorites]


Thorzdad: "See...this is what I just don't understand about politics and political strategy. If I were a Republican strategist and really, truly, honestly wanted to kill this bill, this is the point I would have pushed constantly at the American public..."

I dunno, it seems straightforward to me to avoid that--it would run the significant risk of possibly getting a good percentage of the electorate focused on clamoring for something that did regulate the rates insurance companies charge, and that would have a strong negative impact on campaign donations. Incoherent socialism squalling keeps the electorate in a safer state of generally-predictable percentages, and more importantly, doesn't run the risk of damaging those campaign contributions.
posted by Drastic at 8:54 AM on March 22, 2010


Adding all those people to the pool will drive down rates.

No, it won't, because the insurers will (continue to) fix prices for their collective benefit, as any sensible industry with an antitrust exemption would do.
posted by enn at 8:54 AM on March 22, 2010 [4 favorites]


posted by sotonohito at 8:34 AM on March 22

[tounge pokes out of hole in cheek from cancer ]
Opposing what was passed - that just shows you are a racist and hate the (1/2) black man.
[/goes back to chewing tobacco]
posted by rough ashlar at 8:56 AM on March 22, 2010


There is nothing in the bill to regulate the rates insurance companies charge.
See...this is what I just don't understand about politics and political strategy. If I were a Republican strategist and really, truly, honestly wanted to kill this bill, this is the point I would have pushed constantly at the American public.
The reason that the Republicans didn't do this is that it isn't true in any meaningful sense. I guess one could argue that requiring health insurance companies to spend 80 or 85 cents of every premium dollar on medical costs isn't rate regulation--after all, insurance companies could jack up premiums 50 percent by also suddenly raising the negotiated rates they pay to doctors and hospitals by 50 percent to make sure they still satisfied the minimum medical cost ratio--but in the real world, this is rate regulation. An insurance company will not be able to arbitrarily raise its premiums unless it can prove that the underlying medical costs of its members rose by an equivalent amount.
posted by iminurmefi at 8:57 AM on March 22, 2010 [4 favorites]


Those vile scum are mostly from Republican leaning states, and I don't think their votes against health care reform will save them from the rising tide of teabagger hatred. No one with a "D" in front of their name will survive in areas where the teabaggers have any influence at all, no matter how many hippies they punch.

I don't know if this is true everywhere. In some places the vote will split between Blue Dog voters on one side (a slight plurality) and some blithering idiot Republican "Centrist" cookie cutter robot with perfect hair and a ranting Birther-cum-9/11 Truther on the other side.
posted by Pollomacho at 8:59 AM on March 22, 2010


The reason that the Republicans didn't do this is that it isn't true in any meaningful sense.

Has that ever stopped any politician anywhere from lying to the public?
posted by zarq at 8:59 AM on March 22, 2010


There is nothing in the bill to regulate the rates insurance companies charge.

See...this is what I just don't understand about politics and political strategy. If I were a Republican strategist and really, truly, honestly wanted to kill this bill, this is the point I would have pushed constantly at the American public.
...
Instead, they decided to go into this "OMG teh socialism!!!" mode, and ended-up looking like fucking loons. I just don't understand it.


They have found that the public is more responsive to emotional arguments than dry statistics, and have turned it into a political strategy. Hence, the fearmongering since 9/11.
posted by zarq at 9:03 AM on March 22, 2010


Those that are disappointed need to grow up a bit, maybe a lot.

So being clear-eyed about what we're getting is a sign of immaturity? I think you might have that backwards.
posted by mediareport at 9:07 AM on March 22, 2010 [1 favorite]


Aren't most insurance company rates regulated by the states? In Oregon this is the case, at least. Though, the insurance companies always get the rate increases they ask for.
posted by elwoodwiles at 9:08 AM on March 22, 2010


From John Boehner's Twitter feed:

Health care is NOT a right, it's a PRIVILEGE for those who earn an honest living. If you gangbang&listen to rap all day you don't deserve it

...



...


huh?
posted by orville sash at 9:09 AM on March 22, 2010 [4 favorites]


THAT'S RACIST
posted by mccarty.tim at 9:10 AM on March 22, 2010


Uh, I think I just heard an explosion near the capital.
posted by Ironmouth at 9:10 AM on March 22, 2010 [1 favorite]


Ironmouth, seriously? Or are you being metaphorical?
posted by internet fraud detective squad, station number 9 at 9:11 AM on March 22, 2010


Boehner is seriously losing it. Oh wait, it's a joke account.
posted by mccarty.tim at 9:11 AM on March 22, 2010 [3 favorites]


That's what I get for not paying closer attention, Mccartey.Tim.

Also - . . . explosion?
posted by orville sash at 9:13 AM on March 22, 2010


We will not always be right, but we Democrats have finally acted true. We promised change; Obama ran on a platform that included healthcare reform. He didn't shy away, he didn't hide it until his lame-duck second term. He gave us exactly what we asked for.

Kinda like when Bush was elected for a second term. We could have elected Kerry, but chose instead to stay the course on two wars. As a progressive, I was incensed. But the country had spoken, and we continued on.

It would be great if "elections have consequences" was allowed to be true when the Democrats have power. Instead, it turned into "stop everything, damn the consequences." Remember -- this "fix it in a separate bill" plan wouldn't be necessary if every damn thing wasn't filibustered in the Senate -- by the smallest minority in the US Senate in decades.

The bill is not great. But it is great that we have any bill at all, given the circumstances. You know who to blame for the backroom deals? The Republicans. Again, if you only needed 51 votes to pass something the Democrats could have ignored the worst of the bunch in the party. But, for the first time in history, you need 60 to do *anything*. More than needed for the Bush tax cuts -- more than needed to go to war. So the Cornhusker Kickback (et al) has to happen. It sucks, but lay the blame where it belongs -- on the Grand Obstructionist Party.
posted by andreaazure at 9:13 AM on March 22, 2010 [3 favorites]


I think that was Ironmouth hearing the sound of John Boner (R-Tanning Beds) exploding from the force of his own ironic hypocracy.
posted by mephron at 9:15 AM on March 22, 2010 [1 favorite]


Heh, fair enough, zarq. I suppose in addition to the small matter of it not being true, the main reason that Republicans didn't focus on that message is that any argument that focused on the substance of the bill was a huge loser for them. The more people who were polled learned about the actual substance of the bill, the more they supported it; if you start lying about the lack of rate regulation, it only gives the Democrats a chance to shift the conversation to the actual provisions of the bill, where they had a huge advantage in the court of public opinion.

I'm pretty pleased with the substance of the bill as passed. There are some changes I'd have made if I were dictator but on the whole it's a good bill. The separate funding pools and separate-premium-checks for abortion coverage make me see red a bit, but I'm pretty convinced based on the rest of the bill that we're going to see a huge shift away from fee-for-service payments and towards bundled payments and more provider risk-sharing, which has the potential to make the whole abortion funding question moot. My optimistic crystal ball forecast: by 2020, we're paying doctor groups and hospitals based on how healthy they keep their patients, rather than for the actual procedures that they perform, and as a result the question of covering or not covering an abortion under a certain policy will shift from the insurance companies (who are barred by this legislation from paying outright for an abortion) to the actual physicians and provider groups that provide the care (who aren't constrained by this bill, at least in my reading of it).
posted by iminurmefi at 9:16 AM on March 22, 2010


According to a very reliable source (twitter), there is a thunderstorm in DC right now. Loud noises, but not violent ones (knock on wood).
posted by oinopaponton at 9:16 AM on March 22, 2010


OK it was just a lound thunder really near the capital. I emailed Josh Marshall and Christinia Bellantoni, his Hill reporter said it was thunder. I'm about 8 blocks away, she's in the capital. But that shit was scary, it was out of nowhere, with no other lightning or thunder and sounded so close!
posted by Ironmouth at 9:16 AM on March 22, 2010


Here's another good rundown of what this plan means from the New York Times.

In other news, the current bill shares some similarities with the GOP plan proposed in 1993. So, the GOP seems to oppose this current bill mostly for purposes of political posturing and support from the corporate interests opposed to it.

As for those who oppose the mandatory purchase of health insurance, Massachusetts already has a mandate in place. All spearheaded by Republican Mitt Romney.

In short, people need to get facts from actually studying the issues rather than Fox News or CNN.
posted by reenum at 9:18 AM on March 22, 2010 [6 favorites]


I'm worried. Will the kid in the balloon be safe if this weather keeps up?
posted by mccarty.tim at 9:19 AM on March 22, 2010


OK it was just a loud thunder really near the capital.

Probably the Wrath O' God.
posted by marxchivist at 9:25 AM on March 22, 2010 [2 favorites]


...we all stand on the shoulders of the people who came before us...

Small derail here, but I love this.
You know what, I am going to print this is display it in my home office, so that everytime I act smug about being who I am or where I am, this will remind me of the true secret of my success.
posted by bitteroldman at 9:25 AM on March 22, 2010 [2 favorites]


As for those who oppose the mandatory purchase of health insurance, Massachusetts already has a mandate in place. All spearheaded by Republican Mitt Romney.

It is far from universally accepted that the Massachusetts plan is working out.
posted by Pope Guilty at 9:27 AM on March 22, 2010 [1 favorite]


OK it was just a loud thunder really near the capital.

Probably the Wrath O' God.


Maybe, he just claps really loud.
posted by Rubbstone at 9:29 AM on March 22, 2010 [4 favorites]


So, what are the chances of the GOP taking back the house and doing a repeal?

Zero, because Obama will veto any repeal they pass.
posted by msalt at 9:30 AM on March 22, 2010 [2 favorites]


Some of the right wing blogs are saying that this starts a slippery slope to a single payer system, and the end of the HMO industry as we know it.

As pointed out above, this is a pretty big breakthrough both on this issue and for the democratic majority generally.

For this issue it is just not possible for a simple repeal to happen. Should the GOP do really well in November, they will have to generate actual proposals to deal with the problem of runaway costs. Eliminating medicare for those under 55 is probably not going to win them any friends, so we're looking at a forced situation as medical costs explode and the US Treasury is on the hook for more and more of it. We've crossed the river of maintaining the status quo.

For the democrats generally, they've done about as much as they are going to do in terms of whipping up the GOP base. Might as well get some agenda pushed through. The perception that they are capable of governing and have definable policy positions can't hurt when the public thinks that they want to kill grandma right now.
posted by a robot made out of meat at 9:30 AM on March 22, 2010


people need to get facts from actually studying the issues rather than Fox News or CNN.

Could we please get Fox or CNN to actually study the issues too? The uninformed bleating made by most of the news media these days does them no credit.

Anyways, my wife and I, being proud members of Soviet Canuckistan, followed the debate in the States only partially. Last night we caught an update on ABC about the fact that the Bill had passed, and what the major provisions were. My wife turned to me and said "That's it? On the basis of that, people are marching and calling the plan socialist/fascist?"

So, yeah, congrats on passing it. But there is still a long fight ahead, so don't rest and don't give up.
posted by never used baby shoes at 9:31 AM on March 22, 2010


I suppose in addition to the small matter of it not being true, the main reason that Republicans didn't focus on that message is that any argument that focused on the substance of the bill was a huge loser for them. The more people who were polled learned about the actual substance of the bill, the more they supported it; if you start lying about the lack of rate regulation, it only gives the Democrats a chance to shift the conversation to the actual provisions of the bill, where they had a huge advantage in the court of public opinion.

Yes, exactly. From the outset, Republican talking points focused on abortion. They made an assumption that if they could get enough of their supporters outraged over abortion being covered with taxpayer dollars, they might be able to sink the bill. And lo and behold, they were almost correct. They threw enough confusion into the mix to present an opportunity to pro- and anti-choice activists and politicians and in the end the Dems gave them a major concession.

But abortion wasn't a successful derail, so they tried other tactics and wound up looking unhinged. Meanwhile....
posted by zarq at 9:33 AM on March 22, 2010


To throw my two cents in:

Health insurance is for the healthy. To ensure that in the case something happens to your health, you will be able to address the health issue. Preventative care is an essential piece of this, as it can recognize issues before they are serious and address any possible future issues before they're a concern. It helps keep healthy people healthy.

There's something wrong with society when we've started to think that insurance is a way for the sick to somehow get a discount on large medical bills, or that making a large profit on the well-being of others is a reasonable enterprise.
posted by mikeh at 9:34 AM on March 22, 2010 [4 favorites]


I guess one could argue that requiring health insurance companies to spend 80 or 85 cents of every premium dollar on medical costs isn't rate regulation

Is this actually in the passed bill? I am trying to find information about it but can only find clues that it was dropped for now.
posted by grouse at 9:34 AM on March 22, 2010


So, what are the chances of the GOP taking back the house and doing a repeal? Don't they not have enough money to do that?

First, the odds of them retaking either house of Congress in November look fairly slim at this point. They'll almost certainly have a double-digit seat gain, as most of the swing districts are held by Democrats, giving the Republicans almost literally nothing to lose. But it'd be quite a trick to capture either chamber, let alone both.

Then, they'd actually have to do far better than that, because they'd need a two-thirds majority in both houses to override a presidential veto, which they'd have to do to force a repeal.

Lastly, they'd have to be willing to vote en masse against an entitlement program, which Republicans have generally proved unwilling to do, despite their bluster. People like to complain about bloated government spending, but the fact is that voters generally like social programs. Think anyone on the GOP side is actually going to do anything serious about cutting Medicare or Social Security? It'll be the same with Obamacare.

(And, by the way, once the program is rolled out and becomes massively popular, I predict the Republicans are going to have a serious case of buyer's remorse on the "Obamacare" label.)
posted by EarBucket at 9:35 AM on March 22, 2010


Probably the Wrath O' God.

Well hell did freeze over this morning.
posted by Pollomacho at 9:36 AM on March 22, 2010 [1 favorite]


One last link: Jane Hamsher from Huffington Post dispels some of the myths about the bill.

This is not a perfect bill, far from it. But, it gives us a framework to modify and expand upon.
posted by reenum at 9:37 AM on March 22, 2010


orville sash: Boehner-- "Health care is NOT a right, it's a PRIVILEGE for those who earn an honest living. If you gangbang&listen to rap all day you don't deserve it"

Boehner's twitter feed is comedy gold! Thanks, I thought you made that up. Here's his latest:
Dreamt that Jesus was watching me pull the plug on my own grandma. A single tear fell from his eye. We won't stand for this, America.
posted by msalt at 9:38 AM on March 22, 2010


For the record, @GOPBoehner is a joke account.
posted by Pope Guilty at 9:38 AM on March 22, 2010


Oh, you're no fun.
posted by msalt at 9:41 AM on March 22, 2010


I so wanted it to be real. :(
posted by Pope Guilty at 9:42 AM on March 22, 2010 [4 favorites]


"That's it? On the basis of that, people are marching and calling the plan socialist/fascist?"

I guess ABC cut out the footage from the White House press conference where Mr. Obama stripped naked, waved a Kenyan birth certificate around, carved a pentagram into his chest with a knife that had Hitler engraved on it, and announced an amendment to the health care reform bill that would give everyone over the age of 55 the choice to either face a death squad or convert to being an Atheist Muslim Marxist. It makes a lot more sense in that context.
posted by cmonkey at 9:43 AM on March 22, 2010 [8 favorites]


I'd like to thank whoever pointed out John Boehners twitter feed. Is it really him speaking? I can't believe some of the things he is saying:

"Dreamt that Jesus was watching me pull the plug on my own grandma. A single tear fell from his eye. We won't stand for this, America"

"America... America, are you still there? If you can hear me, I want you to know... I love you"

"So this is how Soviet America begins. The Dems are the REDS -- the real Americans are the WHITES. Tomorrow, we reenact 1918!"

Ah John. I remember some years ago when I was still in high school and yes, I haven't said it before but I went to the same all-male Catholic high school that Mr. Boehner did. And yes, he did come in to speak to us. No cameras or recording devices allowed, just somewhat of an informal speech (albeit he was heavily guarded, even then).

Had I known that Mr. Boehner would turn into the voice of right-wing insanity I would have taken that opportunity to ask Mr. Boehner about healthcare. I can almost guarantee you that he would have been a lot more for it during those heady Bush/Majority Leader days.

I give John credit. He is very, very good at stirring up peoples emotions with his speeches. But sir, if that is indeed your twitter feed, a few points:

- You are screaming treason. A bill has been passed through the means of our Democratic society and yet its still treason to you. Soviet America, that is. The only thing treasonous about passing sweeping social reform legislation is trying to twist it into some kind of back room deal slip up. This was done publicly, hell yes it was, and you have no right to accuse those who voted for the bill when you yourself played the compromise game.

- Compromise. I cannot get my head around the fact that Mr. Boehner and plenty of others make this seem like it was totally one-sided. The votes may have been but the bill is certainly not. Over 200 REPUBLICAN amendments, sir. Over 200. And these were undoubtedly the result of Republicans throwing out their ideas, hoping they wouldn't stick, and having real fuel to campaign against. But the Democrats did compromise, the Right lost it's fuel to rage, and it is very apparent that Mr. Boehner and everybody else opposing this were running on fumes last night.

- Respect. Finally, Mr. Boehner, I beg you sir please grow up. For the sake of this country and it's people - the bill has passed. It's done, it's over. You tried very hard to stop it and you were well within your rights to do so. But to continue to decry this bill is counterproductive. Let it pan out and see what happens. If it turns out to be what it's supposed to be then you are kind of screwed, as you are on record firmly crapping on this bill. If it flops then hey, you have a strong re-election campaign.
posted by deacon_blues at 9:48 AM on March 22, 2010


For the record, @GOPBoehner is a joke account.
posted by Pope Guilty at 9:49 AM on March 22, 2010 [7 favorites]


Wouldn't it be a joke account even if the Hon. Mr. Boehner were actually twitting it?
posted by Pollomacho at 9:53 AM on March 22, 2010 [10 favorites]


Thank god.
posted by deacon_blues at 9:53 AM on March 22, 2010


Health insurance is for the healthy. To ensure that in the case something happens to your health, you will be able to address the health issue. Preventative care is an essential piece of this, as it can recognize issues before they are serious and address any possible future issues before they're a concern. It helps keep healthy people healthy.

No. I pay for health insurance to make sure that if I get sick or am in an accident, I'll be able to afford the care I need, no one will cut corners on diagnostic tests or any other procedures, and ultimately that I'll be able to work and put food on the table for my children once I'm out of the hospital rather than have to declare bankruptcy.

There's something wrong with society when we've started to think that insurance is a way for the sick to somehow get a discount on large medical bills

That's what insurance is. At its most basic definition, insurance is a promise of compensation for specified potential future losses in exchange for a periodic payment.

...or that making a large profit on the well-being of others is a reasonable enterprise.

Good or bad, it's capitalism incarnate.
posted by zarq at 9:54 AM on March 22, 2010


There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.

Someone please correct me if I'm wrong on that.


Uh, the amount they can charge must be related to how much they actually pay for the service. So they can't raise rates past a certain point unless they can show that the costs have gone up. This addresses the real problem.

Consider yourself corrected.
posted by Ironmouth at 9:57 AM on March 22, 2010 [4 favorites]


This addresses the a real problem.

Since we're issuing corrections.
posted by absalom at 9:59 AM on March 22, 2010 [1 favorite]


grouse--Yes, it's in the final Senate bill that was passed, and is retained in the reconciliation sidecar. See item 11 of this PDF list of immediate provisions of HCR, or for an expanded explanation, see page 18 of this PDF summary put out by KFF. The relevant piece (from the KFF link):
Require health plans to report the proportion of premium dollars spent on clinical services, quality, and other costs and provide rebates to consumers for the amount of the premium spent on clinical services and quality that is less than 85% for plans in the large group market and 80% for plans in the individual and small group markets. (Requirement to report medical loss ratio effective plan year 2010; requirement to provide rebates effective January 1, 2011)
That probably won't have too much of an effect on the large group market, where the medical cost ratio is already pretty high (something like 93% for groups with over 1,000 employees). However, it will have a major immediate impact on the small group and individual markets, where administrative costs currently eat up about 25-30 percent of premiums.
posted by iminurmefi at 10:01 AM on March 22, 2010 [2 favorites]


My ex is vehemently and violently Republican, and loathes Obama with the fury of a thousand suns. (Nevermind how we got together.) The difficulty is that she's raised our kids this way since we split up seven years ago. So now I get my daughter snarling at me in Facebook about how her liberty is being taken away and if I don't respect her ideals she won't have anything to do with me ever. My son isn't very chatty, but he mingles his out-of-left-field Christian belief set with similar foam and froth. They're all so opposed to the concept of "socialism" they simply can't see that socialism is all around them in myriad other ways, making society work and function smoothly, even in the mountains of the southeastern US where they're now living.

I'm sure my ex will change her tune about "GRAR SOCIALISM" when her chain smoking turns into emphysema or lung cancer and she finds she can actually get treatment for that despite the fact that she's a small store owner and, until yesterday, essentially uninsurable.

I'm a little bitter about the support payments I send them, but just because they don't think they ought to support a system where everyone helps each other doesn't mean it's okay for me to stop helping them. No, it's not strictly comparable, but I'm not strictly Mother Theresa either.

It just sucks that my kids hate me.
posted by seanmpuckett at 10:04 AM on March 22, 2010 [10 favorites]


socialism is all around them in myriad other ways, making society work and function smoothly

By conflating liberal capitalism with socialism, you're doing the Teabaggers' work for them.
posted by Pope Guilty at 10:06 AM on March 22, 2010 [3 favorites]


--- well, I guess she's still uninsurable, at least until the bill actually passes. I get my hopes up.
posted by seanmpuckett at 10:08 AM on March 22, 2010


So onward to fight for a public option, and a big fuck you to Obama for cutting a deal with the hospitals to kill it. I'll vote for him, as always, because the alternative is worse, but I hope that we all remember that he betrayed us, he lied to us, and he can not be trusted. I thought I was cynical enough not to be suckered by a politician's empty promises, but Obama proved that I wasn't cynical enough. I genuinely thought he was kind of on our side here, that his campaign promises weren't just empty bullshit, and I was wrong. He suckered me, and I'm humiliated to admit that, but I will never be suckered by him again.

You would prefer the status quo? Because that's the alternative. You don't get to pretend that your preferred set of changes was ever on the table. We came precariously close—4 votes, or less than 1%, going the other way—to being saddled with the status quo yet again.

If there's one thing liberals excel at, it's making the perfect the enemy of the good. And it almost cost thirty million people (and growing) any hope they'd have of affordable health care within the next couple of decades.
posted by one more dead town's last parade at 10:08 AM on March 22, 2010 [7 favorites]


States launch lawsuits against healthcare plan:

Republican attorneys general in 11 states warned that lawsuits will be filed to stop the federal government overstepping its constitutional powers and usurping states' sovereignty....

...Ten of the attorneys general plan to band together in a collective lawsuit on behalf of Alabama, Florida, Nebraska, North Dakota, Pennsylvania, South Carolina, South Dakota, Texas, Utah and Washington.

posted by HP LaserJet P10006 at 10:08 AM on March 22, 2010


So, have we heard from Limbaugh's travel agent yet? Or maybe he's just going to see if Paula Deen has a good recipe for corvus cousins?
posted by Pragmatica at 10:09 AM on March 22, 2010


You're right, Pope. I got distracted.
posted by seanmpuckett at 10:09 AM on March 22, 2010


I'm sure my ex will change her tune about "GRAR SOCIALISM" when her chain smoking turns into emphysema or lung cancer and she finds she can actually get treatment for that despite the fact that she's a small store owner and, until yesterday, essentially uninsurable.

Not necessarily. See the tea party stance on Medicare.
posted by grouse at 10:10 AM on March 22, 2010


mikeh - There's something wrong with society when we've started to think that insurance is a way for the sick to somehow get a discount on large medical bills, or that making a large profit on the well-being of others is a reasonable enterprise.

Whereas my perspective is that there's something wrong with society when we start to think that anyone sick should have to worry about medical bills.
posted by Static Vagabond at 10:10 AM on March 22, 2010 [4 favorites]


Not necessarily. See the tea party stance on Medicare.

"Keep the government out of it"?
posted by Pope Guilty at 10:11 AM on March 22, 2010


Republican attorneys general in 11 states warned that lawsuits will be filed to stop the federal government overstepping its constitutional powers and usurping states' sovereignty....

...Ten of the attorneys general plan to band together in a collective lawsuit on behalf of Alabama, Florida, Nebraska, North Dakota, Pennsylvania, South Carolina, South Dakota, Texas, Utah and Washington.


I see they're toeing the "Judges are only vile activists if they disagree with us" party line.
posted by zarq at 10:11 AM on March 22, 2010


So, have we heard from Limbaugh's travel agent yet?

I'm listening to Rush right now, and while I doubt I'll be able to stomach listening to much more, he hasn't mentioned moving south of the border at all. Right now he's blathering about tax on unearned income.
posted by oinopaponton at 10:12 AM on March 22, 2010


So they can't raise rates past a certain point unless they can show that the costs have gone up.

"Can't"?

Let's be specific here. There's no oversight body. Suppose my insurance company decides to raise my premiums unreasonably - it seems to me that my only recourse is to take them to court.

Is this what you mean? Or is there some other mechanism that will prevent insurance companies from raising rates?
posted by lupus_yonderboy at 10:12 AM on March 22, 2010


Does the Tea Party have a stance on anything (aside from what they're against)?
posted by mazola at 10:13 AM on March 22, 2010 [1 favorite]


Republican attorneys general in 11 states warned that lawsuits will be filed to stop the federal government overstepping its constitutional powers and usurping states' sovereignty....

Poor, poor states' rights. Such a neat idea, it's a shame it's always been tied spread-eagled to the blood-stained mattress of injustice.
posted by ROU_Xenophobe at 10:13 AM on March 22, 2010 [4 favorites]


I'm listening to Rush right now, and while I doubt I'll be able to stomach listening to much more, he hasn't mentioned moving south of the border at all.

I don't suppose I expected it, but a man can dream, can't he?
posted by Pragmatica at 10:14 AM on March 22, 2010 [1 favorite]


Poor, poor states' rights.

Politics aside, does anyone know whether this "plan B" opposition lawsuit was anticipated, and also whether anyone feels there's any chance it actually might wind up in the Supreme Court as a Constitutional issue--or whether it will just fizzle out as a legal non-starter?
posted by HP LaserJet P10006 at 10:19 AM on March 22, 2010


Obligatory Terri Schiavo reference.
posted by EarBucket at 10:19 AM on March 22, 2010


Personally, I've always thought of Rush as an angry little gnome who lived in old domestic cars' radios. Considering that he's stuck inside of a Taurus with broken AC, I understand why he's so cranky.
posted by mccarty.tim at 10:21 AM on March 22, 2010 [4 favorites]


LOL, people who thought it wouldn't pass:

Rep. John Boehner (R-Ohio): Health care passing 'over my dead body.' - March 17, 2010
"You know, I've been telling my staff nine months, 'They can't pass this bill.' And finally my staff wrestled me to the ground last fall and said, 'Mr. Boehner, we have to quit saying this because they're gonna pass this bill.' And I looked at my staff and I said, 'Alright, I'll try to throttle it back a little bit. But it'll be over my dead body.'"

Rep. Eric Cantor (R-Va.) - February 25, 2010
"We have to continue the fight to make sure [it is dead]," Cantor says, "but all signs indicate now they cannot pass this in the House

Fred Barnes, The Weekly Standard - January 20, 2010
"The health care bill, ObamaCare, is dead with not the slightest prospect of resurrection. Brown ran to be the 41st vote for filibuster and now he is just that. Democrats have talked up clever strategies to pass the bill in the Senate despite Brown, but they won't fly. It's one thing for ObamaCare to be rejected by the American public in poll after poll. But it becomes a matter of considerably greater political magnitude when ObamaCare causes the loss of a Senate race in the blue state of Massachusetts."

posted by Ironmouth at 10:21 AM on March 22, 2010 [1 favorite]


ok, somebody clue me why Rush wants to move to Costa Rica?

according to this wikipedia, the official language is spanish, which doesn't really seem like his bag; OTOH, it says the population is 80% caucasian? by caucasian, do they mean like the old-skool census way of describing race where hispanics were described as white unless they were specifically described as black or indian?

or is costa rica just full of white europeans who speak spanish (historically called criollos I think), kind of like the ruling classes of much of south america and a good portion of mexico?

please hope me.
posted by toodleydoodley at 10:21 AM on March 22, 2010


I don't really care if the bill is any good or not...it's just nice for our team to win a fucking battle.
posted by vito90 at 10:25 AM on March 22, 2010


"You would prefer the status quo?"

This argument is threadbare and stale. Tiny positive changes are a loss for us, not a win. We only get short periods when we have any control of the government at all - we know that when the bad guys get into office they're going to make major changes in the wrong direction.
posted by lupus_yonderboy at 10:26 AM on March 22, 2010


ok, somebody clue me why Rush wants to move to Costa Rica?

Didn't he get caught coming back from Costa Rica with Viagra he didn't have a prescription for? Not that I would accuse him of anything untoward.
posted by Pope Guilty at 10:28 AM on March 22, 2010


There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.
There is nothing in the bill to regulate the rates insurance companies charge.

Someone please correct me if I'm wrong on that.


"Starting in 2011, it helps states require insurance companies to submit justification for all requested premium increases. Any company with excessive or unjustified premium increases may not be able to participate in the new health insurance exchanges."

A lot of fudge room there, but it's a start.
posted by dig_duggler at 10:28 AM on March 22, 2010


Is this what you mean? Or is there some other mechanism that will prevent insurance companies from raising rates?

I'm not sure, but I'd assume state insurance regulations are minimally required to meet any Federal regulatory standards. So could that be the mechanism? (I'm really not clear on how this part of the legislation works, anyone who can speak with authority from what's in the post-budget reconciliation version on this)?

At any rate, currently, even a state as crappy on insurance regulation as Florida reviews and approves all insurance rate increases. I'd think they would now have to regulate in a way that complies with any new more stringent Federal standards, wouldn't they? Isn't something equivalent already happening in every state at the state governmental level?
posted by saulgoodman at 10:28 AM on March 22, 2010


Tiny positive changes are a loss for us, not a win.

The perfect is the enemy of the good. Just keep plugging, man; that's all you can do.
posted by Pragmatica at 10:29 AM on March 22, 2010 [1 favorite]


Poor, poor states' rights. Such a neat idea, it's a shame it's always been tied spread-eagled to the blood-stained mattress of injustice.

Aside from something being tied to something, I don't really see how this metaphor functions.
posted by a robot made out of meat at 10:30 AM on March 22, 2010 [1 favorite]


ok, somebody clue me why Rush wants to move to Costa Rica?

Probably for the universal healthcare.
posted by Cyrano at 10:30 AM on March 22, 2010 [3 favorites]


Does the Tea Party have a stance on anything (aside from what they're against)?

Socialist!

ok, somebody clue me why Rush wants to move to Costa Rica?

IIronically because of their great socialized helthcare system. (I don't get it either)
posted by Pollomacho at 10:30 AM on March 22, 2010



You know what would get me off?

Osama Bin Laden in chains heading to a federal courtroom.
-- Ironmouth
"Bin Laden Will Never Appear In An American Courtroom" -- Eric Holder
ed: I missed your comment on preview. The affordability subsidies phase out concurrently with the introduction of exchanges where such plans can (hopefully) be purchased cheaply. -zvs
That's completely wrong. The subsides are forever.
My parents have a hard enough time keeping their fucking cars on the road. "Tax credits" is not the same thing as "The government will pay if you can't afford to buy health insurance". -- dunkadunc
Yes, they are. Refundable tax credits go into your pocket, no matter how much money you pay in. So if you have $500 in taxes, and $5000 in tax credits, you get a $4500 check from the government.

---

A far as insurance rates going up, I think there is something in the bill that lets the Dept of health and human services veto rate increases. I think that's in there, or in the sidecar. I know I heard people talking about it, anyone know if that's in the final bill?
You know, it's illegal to drive a car in the UK without car insurance (I'm guessing it's the same in the US). You can get fined and/or your car taken away if you do. Yet, somehow, insurance companies fight to provide the cheapest insurance quotes to attract drivers rather than jacking up the prices because you have to have insurance. -- EndsOfInvention
That's true in the U.S. but unlike Car insurance where you have tons of providers, most people get health insurance through their employer, so they don't get to pick. And in many states, there is only one insurance company that provides almost all of the insurance products. If people try to buy on their own, they really get screwed because there's no collective bargaining.

So, forcing people to buy insurance may not actually work out that well, but once people are forced to do it they'll expect the government to manage the insurance companies properly. If they don't, the government will have a much easier time stepping in.
posted by delmoi at 10:32 AM on March 22, 2010 [1 favorite]


Aside from something being tied to something, I don't really see how this metaphor functions.

I think it's like a car analogy, only instead of a car it's rape.
posted by Pope Guilty at 10:34 AM on March 22, 2010


For some reason, engineering of all sorts is and always has been very popular with far-right conservatives and very religious Christians.

Perhaps it's something about the nature of engineering as a mental discipline: the rigour of absolutes (figures, rules, no room for subjective nuance as in the humanities) combined with directly dealing with the concrete world (as opposed to theory, as physicists and mathematicians, for example, have the luxury of)?
Others have mentioned the "overestimation of their own skills/intelligence" issue, which is a good one. With right-wingers in particular, I think part of the reason there's a correspondence between engineering and political conservatism is that engineering for many is an "aspirational" profession: for a lot of people, a degree in engineering is seen as a path to making money and professional success, without having to "waste" all that time with stuff like medical school or law school. So you get a lot of people who see themselves at the top of the economic/class heap or believe that they deserve to be, or believe that one day they will be, and they vote accordingly, in part in the hopes of being seen as "one of the rich" by other people who are genuinely wealthy: which means they have to be even more doctrinaire conservatives to prove their bona fides, because their actual economic class lies more between the middle and upper middle classes.

I always found that attitude very strange, particularly because I went to a suburban private school where going to school to study engineering was seen as a bit too "working class": the expected path was that you were either going to get rich yourself by pursuing medicine, law, or finance, or you were going to leverage your good education and economic advantages to pursue art or academia.
posted by deanc at 10:37 AM on March 22, 2010


The following is reproduced from __ dig_duggler's link a little up-thread. I'd like for one of the critics to respond point-by-point, and explain to me what's bad about each provision, because to me, it looks like a pretty good deal.
This bill will immediately begin to lower health care costs for American families and small businesses.

o In 2010, small businesses that choose to offer coverage will begin to receive tax credits of up to 35 percent of premiums to help make employee coverage more affordable.

o In 2010, adults who are uninsured because of pre-existing conditions will have access to affordable insurance through a temporary high-risk pool.

o This bill starts to close the Medicare Part D doughnut hole in 2010 by providing a $250 rebate to Medicare beneficiaries who hit the gap in prescription drug coverage. And beginning in 2011, the bill institutes a 50 percent discount on prescription drugs in the doughnut hole.

o Starting this year, new private plans will be required to provide free preventive care: no co-payments and no deductibles for preventive services. And beginning Jan. 1, 2011, Medicare will do the same.

o In 2010, this bill will provide help for early retirees by creating a temporary re-insurance program to help offset the costs of expensive premiums for employers and for retirees ages 55-64.

Under health reform, Americans will see an immediate expansion of coverage.

o This year, children with pre-existing conditions can no longer be denied health insurance coverage. The bill outlaws that practice for new health plans as well as grandfathered group plans. Moving forward, no insurance company can deny a child coverage based on his or her health.

o This year, new health care plans and select grandfathered plans will allow young people to remain on their parents’ insurance policy until their 26th birthday.


o This year, insurance companies will be banned from dropping people from coverage when they get sick, and they will be banned from implementing lifetime caps on coverage. This year, restrictive annual limits on coverage will be banned for new plans and grandfathered group health plans. Under health reform, Americans will be ensured access to the care they need.

o The bill increases funding for community health centers so that nearly twice the number of patients can be treated in their community health centers over the next five years. The funding begins in the next fiscal year.

o The health reform bill will increase the number of primary care doctors, nurses, nurse practitioners and physician assistants through new investments. This funding takes effect in the next fiscal year.

Health reform will immediately curb some of the worst insurance industry practices and strengthen consumer protections.

o Beginning this year, this bill creates a new, independent appeals process that ensures consumers in new private plans have access to an effective process to appeal decisions made by their insurer.

o Starting Jan. 1, 2011, insurers in the individual and small group market will be required to spend 80 percent of their premium dollars on medical services. Insurers in the large group market will be required to spend 85 percent of their premium dollars on medical services. Any insurers that don’t meet those thresholds will be required to provide rebates to their policyholders.

o This year, discrimination based on salary will be outlawed. New group health plans will be prohibited from establishing any eligibility rules for health care coverage that discriminate in favor of higher-wage employees.

o This bill holds insurance companies accountable for unreasonable rate hikes. Starting in 2011, it helps states require insurance companies to submit justification for all requested premium increases. Any company with excessive or unjustified premium increases may not be able to participate in the new health insurance exchanges.

o Beginning this fiscal year, this bill provides funding to states to help establish offices of health insurance consumer assistance in order to help individuals in the process of filing complaints or appeals against insurance co
posted by saulgoodman at 10:37 AM on March 22, 2010 [5 favorites]


Didn't he get caught coming back from Costa Rica with Viagra he didn't have a prescription for?

It was the Dominican Republic. But I still think it's safe to assume that he would move to Costa Rica because the prostitutes are cheaper.
posted by cmonkey at 10:38 AM on March 22, 2010


"Longer wait times, fewer doctors, more bureaucracy, massive IRS expansion, explosive debt, the end of the Pax Americana, and global Armageddon."

Let's see if I can apply this same chain of logic, starting where we are now and extrapolating it to what our national health care system was like before the passage of this bill:

"Letting poor Americans die of treatable illnesses is how we keep freedom alive! Freedom isn't free!!"

How did I do?
posted by the painkiller at 10:38 AM on March 22, 2010


This argument is threadbare and stale. Tiny positive changes are a loss for us, not a win. We only get short periods when we have any control of the government at all - we know that when the bad guys get into office they're going to make major changes in the wrong direction.

Who is this 'we' that is in control of the government right now? Actual liberals make up only a percentage of the democratic party. I still await someone's explication of the steps that could have been taken that would have led to a substantially more progressive piece of legislation then what we got, at this time, with the current rules and composition of Congress. I won't be holding my breath. I'm tired of the unproductive grousing from the left.
posted by Kwine at 10:39 AM on March 22, 2010


I'm tired of the unproductive grousing from the left.

I guess I should probably log off MeFi and get back to work, then.
posted by grouse at 10:41 AM on March 22, 2010 [3 favorites]


heh me too. no more Kwining in this thread either, that's what I say!
posted by Kwine at 10:43 AM on March 22, 2010


Yglesias makes the point that this is a great victory for.... John Edwards?
posted by delmoi at 10:43 AM on March 22, 2010 [1 favorite]


well, guess I'll just toodleydoodley on back to work!
posted by toodleydoodley at 10:44 AM on March 22, 2010


and for those who said that Dem left opposition to this measure didn't help the GOP, take a look at this poll cited by the Hill:

A majority of Americans oppose the health bill passed by Congress but still trust Democrats and President Obama more than Republicans when it comes to healthcare reform, a new CNN poll finds.

Fifty-nine percent of respondents say they oppose the bill passed by Congress. (The poll was conducted before last night's passage). Thirty-nine percent favor the bill.

It should be noted, however, that of the 59% who oppose the bill, 13% do so because it's "not liberal enough." So a majority of respondents (52%) either support the bill or want Democrats to do more.

President Obama still holds an advantage over Republicans. Just about half of respondents--51%--say they trust the president on healthcare, compared to 39% who say the same of the GOP. Congressional Democrats also lead Republicans on the issue, by a margin of 45% to 29%.


Just think of it, the GOP stands with you on the rejection of this bill! Thank god you've got some one to listen to you! Vote Republican and you will get rid of this terrible bill you hate.
posted by Ironmouth at 10:44 AM on March 22, 2010 [1 favorite]


Also, Noam Chomsky supports the bill
posted by delmoi at 10:45 AM on March 22, 2010


Loud noises, but not violent ones (knock on wood).

Really? I'd kind of like for these Tea Party types to actually start putting their money where their mouths are. Then they would get brutally mown down by those cops they love so much.

Actually, scratch that. We don't need them getting any martyrs.
posted by dunkadunc at 10:45 AM on March 22, 2010


delmoi, your link is borked.

I'd love to see his reasoning, though. Chomsky's a sharp dude.
posted by dunkadunc at 10:46 AM on March 22, 2010


"The perfect is the enemy of the good."

It's like you didn't read what I wrote! I said nothing, nada, about perfect. It has nothing to do with wanting perfection.

But if we keep taking one step forward and six steps back, we lose.

I play a lot of Go. Sometimes I play handicap games with weaker players. Often they make "correct" moves all the way - each move is a positive gain for them - and yet they lose. I explained it to my friend this way - "If each of my moves gains more territory than each of yours, then I will win the game, even if I start out with a handicap."
posted by lupus_yonderboy at 10:47 AM on March 22, 2010 [2 favorites]


> my high school history teacher told us 'You have to step up to the plate or you'll fall in the tank and have to dig your way out.'

Thomas Friedman used to teach high school?
posted by Stonewall Jackson at 10:49 AM on March 22, 2010 [9 favorites]


and for those who said that Dem left opposition to this measure didn't help the GOP, take a look at this poll cited by the Hill:
That's a very reductivist approach: Everything that doesn't help democrats helps republicans, Even if republicans and democrats team up for some 'ole fashion "bipartisanship" I suppose.

Yes, people opposed the bill because it was too liberal. But you seem to think that people are just sheep who will do whatever their "leaders" tell them, if only the all powerful Jane Hamsher, Howard Dean, and Joe Beese supported this bill they could have brought along 39 million Americans with them. That's ridiculous. People turn towards leaders who agree with what they already think, to a certain extent, and people would have gravitated to different thought leaders if other mainstream Netroots people all supported the bill 100%

Also, you seem to have this idea that the whole point of liberals is to just backup whatever the mainstream centrist democrats want to do, which is just insane. The point of liberals is to push for liberal policy outcomes. Some people didn't feel the bill measured up, but most supported it in the end.

And anyway, that's just stupid. I realize people in Washington have a warped perspective on this, but democratic leaders are supposed to represent and work for their constituents, not the other way around.
posted by delmoi at 10:50 AM on March 22, 2010


metafilter: Jane Hamsher, Howard Dean, and Joe Beese
posted by HP LaserJet P10006 at 10:52 AM on March 22, 2010


sallybrown, the speculation in the (frequently execrable) comments at the Washington Post is that Texas Republican Louie Gohmert yelled "Baby-killer" at Stupak.

Also notable in those comments:  "Texas Republicans, famous for their rugged sense of independence and wide open spaces between their ears."
posted by NortonDC at 10:56 AM on March 22, 2010 [3 favorites]


"The perfect is the enemy of the good."

It's like you didn't read what I wrote! I said nothing, nada, about perfect. It has nothing to do with wanting perfection.

But if we keep taking one step forward and six steps back, we lose.


Failing to acknowledge the implications of your argument doesn't excuse the point that you didn't say anything about wanting perfection.

But your opinion that this is one step forward, six steps back, is like, your opinion, man.

You need to back that up. How is this bill which seeks to nationally regulate the insurance companies for the first time, set up a floor to coverage offerings, that limits the amount plans can charge relative to costs and gives health insurance to 36 million more Americans is six steps back? Because I'm not seeing it.

And how was your magic bill going to get passed? For months, all this talk about how we needed to twist arms, etc, because the "GOP does it."

Make no mistake about it, the GOP's resistance to this measure was about its impending split between its conservative and bat-shit insane wings, not about its ability to enforce discipline on its members. They are scared of getting eaten by the tea party monster they created. For good reason. But when the pieces are eventually picked up, either the GOP moves somewhat to the left or they are done.

I can't wait until November.
posted by Ironmouth at 10:56 AM on March 22, 2010 [3 favorites]


It's like you didn't read what I wrote!

I read it; it read to me as saying an incremental good is not enough. The first thing that occurred to me is what I wrote.

I said nothing, nada, about perfect. It has nothing to do with wanting perfection. ... But if we keep taking one step forward and six steps back, we lose.

And if you take zero steps forward and six steps back? It's not a game to be won. There's a goal, and you keep working toward it. The steps are sometimes small, and they're sometimes large, and sometimes you slide backward. In my opinion, though, it's counterproductive to bemoan the size of the step you took.
posted by Pragmatica at 10:57 AM on March 22, 2010


Can Congress punish the member who shouted "baby killer" at Bart Stupak?
posted by homunculus at 10:57 AM on March 22, 2010 [2 favorites]


Just think of it, the GOP stands with you on the rejection of this bill! Thank god you've got some one to listen to you! Vote Republican and you will get rid of this terrible bill you hate.

There's triumphalism and then there's being a dick about it.
posted by Pope Guilty at 10:58 AM on March 22, 2010 [2 favorites]


Actually, the liberal Democrats vs. centrist Democrats vs. conservative Democrats dynamic ended up being the perfect narrative for Obama's purposes. Republicans ended up sitting on their hands and letting Bart Stupak carry the anti-abortion flag because they thought an intra-party fight would weaken the party more than a Democrats vs. Republicans narrative. Instead, Stupak got right up to the last minute and rolled over in exchange for a completely symbolic piece of paper from the president, then gave a rousing speech urging the Blue Dogs to vote against the motion to recommit and pass the bill. In an instant, the only serious roadblock to passage was gone. There's a small part of me that wonders if the whole thing was a set-up.
posted by EarBucket at 10:59 AM on March 22, 2010 [4 favorites]


That's a very reductivist approach: Everything that doesn't help democrats helps republicans, Even if republicans and democrats team up for some 'ole fashion "bipartisanship" I suppose.

When the GOP commits to all out 'bar the door of the University of Alabama' style-resistance, then a very reductivist approach is appropriate.

Avoiding dealing with the enemy in your plans is a fatal error. It almost cost us this bill. Luckily people woke up and voted right. The left continued to ignore the GOP and the pressure that it could put on Dem members in certain districts when it engaged in its strategy for this bill. Luckily for them, our hard work will give them years to add to this bill and make it better.
posted by Ironmouth at 11:00 AM on March 22, 2010


There's a small part of me that wonders if the whole thing was a set-up.

I am with you there. Right up until the Brown vote, the battle was over the most liberal part of the legislation, the Public Option. Obama had them fighting over his "hope to get this if I can" stuff. They avoided the meat and lost.
posted by Ironmouth at 11:02 AM on March 22, 2010


I still await someone's explication of the steps that could have been taken that would have led to a substantially more progressive piece of legislation then what we got, at this time, with the current rules and composition of Congress.

This has been provided to you numerous times in this thread (and these are all hypotheticals anyway) but let me clear it up for you.

Let's start with Mr. Obama. If he had not given up the majority of his bargaining leverage at the start of this process, imagine how much more of a bill we could have gotten?

Obama-the-candidate talked about "single payer". The moment he became Obama the candidate, single payer was so off the table that it wasn't allowed to be mentioned at any time and people who were did were arrested.

Now whether or not single-payer was attainable, asking for more than you can get is only common sense in bargaining.

You could say exactly this about "the public option". I actually believe that the public option was attainable - certainly there was enough support for it about - but Mr. Obama gave that away.

Similarly with the secret giveaway to Big Pharm. They get the bill they like - in exchange, they cut 2% (really!) off their profits, so they only double their profits over the next ten years.

Again, these are all hypotheticals - who knows what might have happened? But as a negotiator and a game player, I'd say the Democrats did a piss-poor job and could have negotiated a much better outcome.
posted by lupus_yonderboy at 11:03 AM on March 22, 2010


seanmpuckett: "

It just sucks that my kids hate me.
"

That does suck. If it's any consolation, pretty much everyone I'm biologically related to, except my little kids, hates me - or at least thinks I'm in league with the Marxist/socialist/nazis for the same reason.

It makes me surprisingly sad. When did this shit become so personal? I don't mind someone thinking I'm wrong, but someone telling me that I'm a bad person because we differ politically? I know I tossed around some epithets last night while watching the debate, called some names at the TV, but I don't HATE those people, I just think they're WRONG, and if we were ever in the same room, I'd like to think I could treat them with some basic civility. And yet, I can't get that same respect from my family, people I grew up with?

There's something really broken here, and I don't think it's (just) politics.
posted by Lulu's Pink Converse at 11:04 AM on March 22, 2010 [8 favorites]


I'm seriously hoping, by the way, that Boehner's speech from last night makes it into a bunch of Democratic campaign ads this fall.

ATTRACTIVE COLLEGE STUDENTS: Can we stay on our parents' insurance until we're twenty-seven?

JOHN BOEHNER: No you can't!

SWEET-FACED LITTLE OLD GRANDMOTHER: Can I have help buying the prescription medications I need to live?

JOHN BOEHNER: No you can't!

ADORABLE LITTLE BOY WITH PUPPY: Can I be covered by my parents' insurance company, even though I have a pre-existing condition?

JOHN BOEHNER: Hell no, you can't!

Etc, etc.
posted by EarBucket at 11:04 AM on March 22, 2010 [34 favorites]


They are scared of getting eaten by the tea party monster they created.

I doubt it: the "Tea Party" is mostly a media creation, and the actual number of its constituents and sympathizers is negligible. Yesterday there were many more people out in the Mall protesting for immigration reform (who are no doubt regretting their timing) than protesting HCR. Even though Romney and Newt are ratcheting up the rhetoric, I suspect GOP analysts will soon realize that merely being against HCR now is not nearly the political gold they think it is.
posted by HP LaserJet P10006 at 11:04 AM on March 22, 2010 [1 favorite]


Just think of it, the GOP stands with you on the rejection of this bill! Thank god you've got some one to listen to you! Vote Republican and you will get rid of this terrible bill you hate.

There's triumphalism and then there's being a dick about it.


I can't help it if your position was providing much needed help to the GOP. I can't help it if your continuing stance against this now passed legislation provides much needed help against the GOP. That's a cross you'll have to bear. Positions like the ones you and others have staked out for a long time have materially harmed the effort to bring health insurance to 36 million more Americans. Once it was obvious that the GOP was going for all-out resistance, any position that was not helping out was positively supporting the GOP, flat the fuck out.
posted by Ironmouth at 11:06 AM on March 22, 2010 [1 favorite]


But your opinion that this is one step forward, six steps back, is like, your opinion, man.

Your reading comprehension is poor.

This is one step forward. We all agree, right?

We have experienced dozens of steps backward over the last decade. We all agree too, right? This isn't just "my opinion", yes?

Inevitably, there will be another Republican administration. Agreed?

And based on past performance, it's not so unreasonable to expect that they'll again come up with ways to make dozens of steps backward. Do you disagree?

If we make tiny scores when the Democrats are in, and huge losses when the Republicans are in, then we end up losing overall. What do you think?

Is this, like, my opinion, man? Or is this a very accurate portrayal of how the "Dems vs. Reps" power game has gone for, like, the last 30 years, dude?
posted by lupus_yonderboy at 11:08 AM on March 22, 2010 [2 favorites]


toodleydoodley: by caucasian, do they mean like the old-skool census way of describing race where hispanics were described as white unless they were specifically described as black or indian?

Yes, and there's nothing old-school about it. We Latinos are an ethnically diverse group. The 2010 census makes the distinction between race and ethnicity for Hispanic Americans as well, since there are White Hispanic Americans as well as Black Hispanic Americans and Hispanic Americans of every other background.
posted by joedan at 11:10 AM on March 22, 2010


I actually believe that the public option was attainable - certainly there was enough support for it about - but Mr. Obama gave that away.

You might as well say Ms. Pelosi gave it away, because it was Pelosi who originally nixed the idea of reintroducing the public option provisions through reconciliation in the House.

And that happened before, not after, President Obama excluded it from his final proposal meant to resolve the House and Senate differences (and used as the basis for the budget reconciliation bill's changes). And it happened because there weren't enough votes in the House.

Remember, even Rockefeller, who introduced the public option when it came up originally in the House, said he would not support including the public option through the budget reconciliation procedure.
posted by saulgoodman at 11:11 AM on March 22, 2010


When the GOP commits to all out 'bar the door of the University of Alabama' style-resistance, then a very reductivist approach is appropriate.

Avoiding dealing with the enemy in your plans is a fatal error. It almost cost us this bill.
Yeah, but it didn't. Recrimination in loss is pretty common, but you have to be pretty bitter to recriminate in a success. Reminds me of when Carville started attacking Howard Dean after the dems took the congress in '06. More interested in settling scores with other liberal factions then enjoying success.

Pretty lame.

Anyway, The point is the whole argument is stupid. People are liberal activists because they care about stuff. If they didn't care about stuff, they wouldn't be activists and they wouldn't help you with anything else.

There are obviously a lot of people who just love Obama and the dems and do whatever they can to support them regardless of actual policy, but not a majority. Some people actually care about policy, and will oppose something if it's not good enough, and if they think they can get something better.

And more then that, the whole self-entitled aspect is really obnoxious. No one cares whether you think they owe you their support. They just don't.
posted by delmoi at 11:11 AM on March 22, 2010 [4 favorites]


Now whether or not single-payer was attainable, asking for more than you can get is only common sense in bargaining.

As someone who engages in settlement negotiations almost daily, there is nothing more damning to your cause than taking a negotiating position which is out of step with reality. Do you ask for $1,000,000.00 for a $500k house? No. People won't even negotiate with you if you are stupid enough to do that. They rightfully assume that you are going to be a piece of shit. And when you bounce down from $1,000,000 to $550,000 in a single bound, you'll find the ground slipping away pretty quickly.

Effective negotiators start with a position with a basis in reality. It forces a better offer from the other side than going off the reservation, let me assure you.

And everyone knew that single-payer didn't have the votes. So it wasn't a position people could take.

And in that sense, what the GOP did was tactically right. They stopped the public option with the wall of resistance. The minute they decided they were going to be 100% against the legislation, the public option was dead. But it is going to cost them electorally now.
posted by Ironmouth at 11:12 AM on March 22, 2010 [17 favorites]


Some people actually care about policy, and will oppose something if it's not good enough, and if they think they can get something better.

And more then that, the whole self-entitled aspect is really obnoxious. No one cares whether you think they owe you their support. They just don't.


I'm saying the position was short-sighted and hurt us. And if the GOP is going to continue to resist like this, we need a plan that takes that into account. Nobody is entitled to support. But we're better off if the folly of that position is acknowledged and taken into account for the rest of the Obama Administration.
posted by Ironmouth at 11:14 AM on March 22, 2010


But that shit was scary, it was out of nowhere, with no other lightning or thunder and sounded so close!

OMG ITS THE WEATHERMEN! BOMB THE SKY!
posted by Kirk Grim at 11:16 AM on March 22, 2010


I'm saying the position was short-sighted and hurt us.

How did it hurt you? You got the fucking bill passed.
posted by HP LaserJet P10006 at 11:16 AM on March 22, 2010


Saulgoodman...Thanks for the rundown. I note a lot of the items are targeted at new plans (group and individual) and grandfathered existing group plans. There seems to be a big emptiness concerning existing individual plans. Does anyone know if those of us already buying our own individual plans are going to be left hanging, as far as these new protections are concerned? Or are they included but simply not mentioned? Yes, I can be that paranoid...
posted by Thorzdad at 11:16 AM on March 22, 2010


tl;dr all the comments. but i just got back from the break room where the limbaugh brothers--3 cajuns, a cracker, and an angry young white man of unknown state origin--are loudly decrying the launch of the ussa.

'now we'll just abort all the american babies so we won't have anyone working tax-paying jobs and the illegals will pop out kids who suck up all the taxes.'

and

'now that teenage girls know they can get a free abortion any time they want they'll be getting pregnant all the time.'

etc.

call me a coward, but i did what i usually do--gritted my teeth, finished washing my lunch dishes, and beat a path out of there before i physically or verbally smacked someone.

sorry to name check you in this joe beese and pope guilty, but keep saying what you're saying. because to some of us, reading this obama/democrat/health care pep rally thread sounds a whole lot like the other side of the limbaugh brothers spouting their party line.
posted by msconduct at 11:17 AM on March 22, 2010


In my opinion, though, it's counterproductive to bemoan the size of the step you took.

Well, let me give you a real world example. You have a family and a job that pays you $100K. You need at least $60K to live. Suddenly, your company closes.

By your argument, you should immediately go to work at McDonalds. Admittedly, you are now bringing in $20K, but it's better than nothing. And you shouldn't be bemoaning that you only made $10 the last hour - it's counterproductive to bemoan the size of the step you took.

Here's another argument. Suppose we play poker, and you're a better bettor than I am. We win about the same number of pots - but the pots that you win are twice the ones that I win.

I claim that I should be looking at these tiny pots and saying, "I need to improve my bettering strategy, because overall I'm losing my shirt." You claim that this is counterproductive for me. Who's right?

Also - see my Go argument above.

In the last 30 years of US governance, we've made about six steps forward and fifty-seven backward. You're fine with your six steps - I am not.
posted by lupus_yonderboy at 11:18 AM on March 22, 2010 [2 favorites]


And in that sense, what the GOP did was tactically right. They stopped the public option with the wall of resistance. The minute they decided they were going to be 100% against the legislation, the public option was dead. But it is going to cost them electorally now.
That's actually pretty insane. Republican votes would have made the public option even less likely. In fact, their resistance to any deal made the plan much more liberal: Yglesias:
But David Frum is largely on board with my interpretation, though I think he in many ways goes too far. Frum’s point is that if conservatives had been willing to engage constructively in the negotiations on the big enchilada, they could have gotten a more conservative version of universal health care. After all, Max Baucus wanted conservatives to engage constructively in the negotiations and all signs are that he wanted a more conservative bill.

My point is even more basic—at a couple of moments along this race the conservatives won the argument and Democrats were ready to buckle. Credit for not buckling goes to Nancy Pelosi and other gutsy leaders. But it also goes to the GOP. They wouldn’t take “yes” for an answer when lots of people wanted to surrender and settle for something much smaller. Instead, whipped up into a frenzy of ideological fanaticism and overconfidence, they decided to take no prisoners. So nobody surrendered! And that’s how Mitch McConnell brought universal health care to America. And the thing of it is that most conservatives are so shallow, and so driven by hippie-hatred rather than any real views, that if they get to use this as an “issue” to win seats in the midterms and it never gets repealed, they’ll consider themselves vindicated.
Of course, it's all subjective. But I find your subjective analysis to be pretty whack in general.

Anyway, what's your problem? HCR passed and now you're picking fights with liberals for no reason. Talk about bitter.
posted by delmoi at 11:21 AM on March 22, 2010 [1 favorite]


There is nothing in the bill to regulate the rates insurance companies charge.

So what?!?

Before this bill, insurance companies had it all their way. They could cherry-pick the customers, and kick out the expensive ones, have whopping deductibles, and control costs.

Now, with just about all Americans in the health care market and alot of the exclusionary tricks forbidden, it's more truly a genuine marketplace. Some upstart, a "GEICO" for the health insurance market, is going to see opportunity and go for it, and the rest will have to follow or die.

I'm not that worried about the anti-trust exclusion either. The magnifying glass is going to be on the health care insurers for at least the next two years; we're gonna get front-page reporting of what company just paid bonuses or installed latte machines.

Finally, if the government can call Toyota up onto the carpet for some sticking gas pedals, you can damn well bet they'll be equally ready to call in the health-insurance industry leaders if rates get out of hand.

(Being a Canuck, I of course know that single payer is the way to go, but I'm happy to see our good neighbours make any forward progress on health care. )
posted by Artful Codger at 11:22 AM on March 22, 2010 [2 favorites]


Inevitably, there will be another Republican administration. Agreed?

And based on past performance, it's not so unreasonable to expect that they'll again come up with ways to make dozens of steps backward. Do you disagree?

If we make tiny scores when the Democrats are in, and huge losses when the Republicans are in, then we end up losing overall. What do you think?


First, I don't know if there will be another GOP administration. Conservative, yes. But that party is in a heap of trouble right now.

My problem is with your mischaracterization of this step as "tiny."

Let's look at the reality, shall we? Was Civil Rights a "tiny" step? Nope. And for all of the steps back, we have a black president and record black engagement in the political process throughout the South.

Was Social Security a "tiny" step forward? Fuck no. And it lives today and will be fixed and continue to live.

Was Medicare or Medicaid a "tiny" step forward? No. And have the Republicans even come anywhere near repealing it? No. Defending Medicare was the center of their strategy.

This was a giant leap forward. Titanic. Look at the level of GOP/conservative resistance to this each and every time it has come up. They killed TR's HCR, Roosevelt's HCR, Truman's HCR, JFK's HCR, LBJ's HCR and Clinton's HCR. All with all-out resistance.

Acknowledge that your position requires you to take the position that somehow, passing something that bedeviled the greatest Presidents of the 20th century is minor.

Really look at these 'tiny scores' they are all pretty damn big.
posted by Ironmouth at 11:22 AM on March 22, 2010 [10 favorites]


HCR passed and now you're picking fights with liberals for no reason.

Exactly: the 34 "DINO" lawmakers who voted against the bill yesterday are the problem, not the progressives who thought the bill was too weak.
posted by HP LaserJet P10006 at 11:23 AM on March 22, 2010 [3 favorites]


There is nothing in the bill to regulate the rates insurance companies charge.

So what?!?


Yeah, especially since it's not even true.
posted by saulgoodman at 11:24 AM on March 22, 2010


Anyway, what's your problem? HCR passed and now you're picking fights with liberals for no reason. Talk about bitter.

Ironmouth, I agree with you more often than not, but delmoi's right on this one. Everyone's pretty wound up over this, but you're fighting a battle that's over. Take a deep breath and save that anger for fighting the Republicans the next eight months. We're going to need every ounce of it.
posted by EarBucket at 11:27 AM on March 22, 2010 [1 favorite]


I can't help it if your position was providing much needed help to the GOP. I can't help it if your continuing stance against this now passed legislation provides much needed help against the GOP.

I think the insistence, as seen in this quote and elsewhere around the web, in framing this legislation not in terms of whether it's good or bad or good enough or not good enough, but as part of a tribalist, our-group-good-their-group-bad narrative, is really problematic. I honestly and sincerely disagree with you about what you and I believe that the bill will accomplish and/or not accomplish; I am trying to discuss and to not be fighty. I feel like your tone here, along with several other peoples', is nasty, and unwarrantedly so.
posted by Pope Guilty at 11:27 AM on March 22, 2010


And another thing because the republicans refused to negotiate, the centrists who wanted A bill had to negotiate with the liberals who were on the fence about the bill not being liberal enough. Therefore, we got a more liberal bill then we otherwise could have.
posted by delmoi at 11:27 AM on March 22, 2010 [1 favorite]


'now that teenage girls know they can get a free abortion any time they want they'll be getting pregnant all the time.'

There was a time, not long ago in America, where a bunch of ignorant guys in a bathroom would be lauding the idea of teenaged girls with loose morals.
posted by Pollomacho at 11:27 AM on March 22, 2010


lupus_yonderboy - We appear to be talking past each other, and it's probably my fault. Let me see if I can use your own example:

You need 60K to live. There's only a $10/hour job to be had. The goal is 60K, but in the absence of 60K jobs, you do what you can. Doing nothing at all but bemoaning the lack of 60K jobs gets you nowhere.

The other two examples do a fine job of illustrating the point that when two people are racing to get to the same place, the person who does so fastest wins. In my opinion, that's not what this is about. To me, it's about pointing at a place and saying 'I will get there.' You then start walking.
posted by Pragmatica at 11:28 AM on March 22, 2010


As someone who engages in settlement negotiations almost daily, there is nothing more damning to your cause than taking a negotiating position which is out of step with reality.

Ah, this is the fundamental argument being revealed! Any form of real progress is "out of step with reality". This is the argument as to why we can't get real health care, why we can't close Guantanamo, why we must quickly expand the war in Afghanistan and slowly end the war in Iraq - because doing anything substantial is "out of step with reality".

What's so sad about your argument is that the Republicans constantly take negotiating positions that are "out of step with reality" - positions that only a minority of Americans support, and that are moreover batshitinsane. So why does it work so well for them, eh?

Because political negotiations aren't like buying a house but are closer to a war (or a strategy game) where surprise attacks and massive reverses are commonplace. Because a house has a well-known price, because I can compare houses with other houses that recently sold, because if I don't like that house there are tons of other houses I can buy, because there aren't hundreds of millions of people involved and massive emotions on each side.

The fact is that there was at various times surprisingly strong support for single payer and majority support for the public option - despite both parties being unanimous in their lack of support for them. I don't think you can make any case at all that a public option was out of step with reality.
posted by lupus_yonderboy at 11:30 AM on March 22, 2010 [3 favorites]


Anyway, what's your problem? HCR passed and now you're picking fights with liberals for no reason. Talk about bitter.

This is not for no reason. If financial reform is backed up against GOP opposition like this, are you going to tell you when the pollsters call that you are opposed because this or that is still in there? What about every other part of the President's agenda? I'm not saying people should just blindly do what Obama says either--what I'm saying is that if the GOP is going all out to stop a program, the best way to get some part of what you want is to combine together.

Not only that, but the haters came out first saying the plan sucked up top in this thread. And it doesn't. And there is going to be a big battle to implement it. And when the pollsters call and you say it sucks and shouldn't be passed, don't be surprised if gee, the GOP uses that to say "America has spoken and they are against this bill" when America is really for the basics of the bill.
posted by Ironmouth at 11:30 AM on March 22, 2010


Pope Guilty: This is the crux of my opposition: if we really want better health care- and cheaper health care- we need to get people in to see GPs. Shitty, bottom-tier insurance with high deductibles and co-pays does nothing to accomplish that.

So what do you say about this?

Many have been concerned that there will be a shortage of primary care doctors to deal with the influx of new patients. Starting in 2010, a variety of new loan repayment and scholarship programs kick into effect. But more importantly, in 2011, the government directly expands primary-care training programs and sends a 10 percent increase in payments to primary care doctors in the Medicare program (which makes being a primary care doctor relatively more lucrative).

As a side note, Ezra Klein has been on fire today. I think anyone worried about costs should read his post, "How big is the bill, really?"
posted by joedan at 11:31 AM on March 22, 2010


Ironmouth--Kucinich came out for the bill. To my knowledge, none of the 34 Democrats against the bill were against it b/c it was not progressive enough. So you are just trying to score points, and being preachy about it to boot. Enjoy your victory, and stop trying to settle old scores.
posted by HP LaserJet P10006 at 11:33 AM on March 22, 2010


Many have been concerned that there will be a shortage of primary care doctors to deal with the influx of new patients.

So we should be against healthcare reform becuase more people will get access to healthcare?
posted by Pollomacho at 11:34 AM on March 22, 2010 [1 favorite]


And in that sense, what the GOP did was tactically right. They stopped the public option with the wall of resistance. The minute they decided they were going to be 100% against the legislation, the public option was dead. But it is going to cost them electorally now.

It wasn't about blocking the public option, it was about blocking anything. The Republican 100% Wall of No was a gamble that only paid off if it worked to prevent Obama and the Democrats from delivering on the big promises they made to the majority who elected them.

Yesterday, that gamble blew up in their faces. We're going to watch the Republican electoral coalition and Republican congressional unanimity spin to pieces like the Challenger in the next months.
posted by gum at 11:35 AM on March 22, 2010 [1 favorite]


George R. R. Martin on the passing of healthcare reform.

Would Doc Tachyon work for an HMO?
posted by robocop is bleeding at 11:36 AM on March 22, 2010 [1 favorite]


hey speaking of insurance i have spent all morning trying to find an otolaryngologist who is on the list, is still at the listed number, isn't retired or dead, still taking new patients, actually takes the insurance my insurance says he takes, and has a free appointment before late fucking april

boy oh boy single payer sure would have sucked i would hate to just get a referral from a gp and just be able to, you know, fucking go
posted by Optimus Chyme at 11:37 AM on March 22, 2010 [5 favorites]


I don't think you can make any case at all that a public option was out of step with reality.

It was the minute the GOP's scorched earth tactics came on board. It is like a war. You have to react to your enemy.

Because political negotiations aren't like buying a house but are closer to a war (or a strategy game) where surprise attacks and massive reverses are commonplace. Because a house has a well-known price, because I can compare houses with other houses that recently sold, because if I don't like that house there are tons of other houses I can buy, because there aren't hundreds of millions of people involved and massive emotions on each side.

Actually a good point. I reached on that metaphor, because my negotiations are a lot like political negotiations/war. I negotiate settlements to cases. But few people have experience with that. So I came up with the house analogy. But the fact is, you have got to start out with a realistic number in those negotiations. And Single Payer has never, ever, ever had the votes.

Any form of real progress is "out of step with reality". This is the argument as to why we can't get real health care, why we can't close Guantanamo, why we must quickly expand the war in Afghanistan and slowly end the war in Iraq

don't you see what you are doing? You aren't making an argument at all. You merely label anything less than what you wanted as "not real progress." It isn't "real health care." That's why I'm saying its "like, your opinion, man."
posted by Ironmouth at 11:38 AM on March 22, 2010 [4 favorites]


You need 60K to live. There's only a $10/hour job to be had. The goal is 60K, but in the absence of 60K jobs, you do what you can. Doing nothing at all but bemoaning the lack of 60K jobs gets you nowhere.

That is completely not what I said.

I did not say that there is only a $10 hour a job to be had. No no no no no. Nor did I say that your other solution was to do nothing. No no no no no.

In this little story you have two strategies.

One is the "any financial progress is good" strategy - where you immediately start working for $10.

The other one is the "look for something better" strategy - you do NOT take the $10 an hour job, so you make no immediate financial progress at all - but instead you start looking for another $100K a year job.

Clearly the second strategy is better... right? Because in the long run you'll do better with the $100K job, or even if you miss it, you might still get the $60K job that will let you survive.

In the same way, if you only have a limited time to make progress, sometimes you have to give up on small gains so you can spend your time working toward making larger gains.

This is common sense; it's logic; it's game theory; and it's standard negotiation theory. (If you're always getting every deal you bid on, then your prices are too low...)
posted by lupus_yonderboy at 11:38 AM on March 22, 2010 [1 favorite]


Yesterday, that gamble blew up in their faces. We're going to watch the Republican electoral coalition and Republican congressional unanimity spin to pieces like the Challenger in the next months.

I have to say I find your analogy immature, unnecessary, and offensive.
posted by mazola at 11:40 AM on March 22, 2010 [6 favorites]


It wasn't about blocking the public option, it was about blocking anything. The Republican 100% Wall of No was a gamble that only paid off if it worked to prevent Obama and the Democrats from delivering on the big promises they made to the majority who elected them.

Yesterday, that gamble blew up in their faces. We're going to watch the Republican electoral coalition and Republican congressional unanimity spin to pieces like the Challenger in the next months.


I agree that politically, that's what they were trying for. They killed the Public Option though. Of course if they blow themselves up as we both seem to think they will, then it will all be worth it, because it will be easier to get our agenda enacted.
posted by Ironmouth at 11:40 AM on March 22, 2010


$695 per year up to a maximum of three times that amount ($2,085) per family penalty. I think I'll invest in a semi automatic to shoot whatever government enforcement agency comes knocking first.

Assess employers with more than 50 employees that do not offer coverage and have at least one full-time employee who receives a premium tax credit a fee of $2,000 per full-time employee, excluding the first 30 employees from the assessment. So if the business is looking to open a new facility, and needs to hire just one more person, will they look at the bottom line and not open a new business for fears it would now cost more to expand? Jobs are going to be lost.

New annual fees? WTF? Seriously, what is the point of being in business if all these new fees, tax, are just going to drive everything away? Indoor tanning is now an illegal lifestyle choice. I'm thinking they may not like salt in food, water in beer, and sugar in candy next without a 35% fee on those products.

Independent Payment Advisory Board comprised of 15 members to submit legislative proposals containing recommendations to reduce the per capita rate of growth in Medicare spending if spending exceeds a target growth rate. Good luck with that board getting anything passed.

This bill oversteps a lot of states rights and hopefully gets sent back to the dumpster where it belongs.
posted by brent at 11:42 AM on March 22, 2010


Whens the next "Obama just sits on his ass and hasn't really done anything" thread due again?
posted by Artw at 11:42 AM on March 22, 2010 [1 favorite]


I have to say I find your analogy immature, unnecessary, and offensive.

Seconded. Flagged.
posted by EarBucket at 11:42 AM on March 22, 2010


shortage of primary care doctors

If there is a shortage of doctors, blame the AMA.
posted by Blazecock Pileon at 11:43 AM on March 22, 2010 [2 favorites]


I think I'll invest in a semi automatic to shoot whatever government enforcement agency comes knocking first.
posted by brent at 11:42 AM on March 22


lol you do that buddy
i'm sure you can outshewt em all
posted by Optimus Chyme at 11:44 AM on March 22, 2010 [7 favorites]


One is the "any financial progress is good" strategy - where you immediately start working for $10.

The other one is the "look for something better" strategy - you do NOT take the $10 an hour job, so you make no immediate financial progress at all - but instead you start looking for another $100K a year job.


this is the fallacy of the missing middle. We aren't saying "anything is good." We are saying this is a continum and the plan does a whole hell of a lot of good, regardless of your inability to do anything other than say "its not real reform." Therefore it is worth it, even if we didn't get a perfect plan

Plus your premise that there is nothing good in the bill is totally flawed. This is going to ensure 36 million more americans, reduce the budget deficit and get costs under control.

but at the core of your issues is this--you overestimate your ability to pass that agenda you think is so easy to get. Gee, if only you were in charge that Stupak would have said "yes sir!" If it is so damn easy, why wasn't it done? Somehow you know better than the people who actually got the work done!
posted by Ironmouth at 11:44 AM on March 22, 2010


Yesterday, that gamble blew up in their faces. We're going to watch the Republican electoral coalition and Republican congressional unanimity spin to pieces like the Challenger in the next months.

Classy.
posted by zarq at 11:45 AM on March 22, 2010


Assess employers with more than 50 employees that do not offer coverage and have at least one full-time employee who receives a premium tax credit a fee of $2,000 per full-time employee, excluding the first 30 employees from the assessment. So if the business is looking to open a new facility, and needs to hire just one more person, will they look at the bottom line and not open a new business for fears it would now cost more to expand? Jobs are going to be lost.

Hardly. These types of things are in all legislation applying to business. Its how you exempt small business. That includes anti-discrimination laws in lending etc. But has business slowed to a crawl? Nope.

This thing is a done deal.
posted by Ironmouth at 11:47 AM on March 22, 2010


And in that sense, what the GOP did was tactically right. They stopped the public option with the wall of resistance.

That's actually pretty insane. Republican votes would have made the public option even less likely.


Sorry guys, but this is nonsense. There was a deal to kill the public option; the Rs didn't need to do anything to stop it. It looks like we won't even get to see a vote on it, as Sanders has flipped on his promise to force one. Not one Senator now stands behind it.
posted by mek at 11:47 AM on March 22, 2010 [4 favorites]


Fucking hell, you lot are thin skinned. What's next, pissy remarks if someone refers to something blowing up like the Hindenburg or sinking like the Titanic?
posted by Artw at 11:48 AM on March 22, 2010 [13 favorites]


I think I'll invest in a semi automatic to shoot whatever government enforcement agency comes knocking first.
posted by brent at 11:42 AM on March 22


I have to advise you not to get into shootouts with the cops. It never pays.
posted by Ironmouth at 11:48 AM on March 22, 2010


Ironmouth wrote: "You aren't making an argument at all."

Say, what?

I wrote a long and complex argument. Your rebuttal was "out of step with reality". I wrote at length explaining why the public option was definitely not "out of step with reality". Your rebuttal is "it's, like, your opinion, man".

I can certainly cut and paste my arguments again if you like. But I suspect you'll simply say I'm "unrealistic" again - how can I compete with a vacuous argument like that?


"You merely label anything less than what you wanted as "not real progress.""

I picked these as examples of issues where we got essentially no progress at all.

Guantanamo Bay is not closed. It's not clear it'll ever be closed. We know for a fact that many men in there will never receive a trial of any type.

We're still in Iraq and we're not even keeping to Bush's withdrawal timetable.

We're expanding the war in Afghanistan. That's negative progress.
posted by lupus_yonderboy at 11:48 AM on March 22, 2010 [2 favorites]


mazola: Does the Tea Party have a stance on anything (aside from what they're against)?

They're for having their cake, and eating it too. As long as poor people and colored folk can't have any.

That is to say, they want to balance the budget and also slash taxes (?!) meanwhile getting rid of all forms of welfare that don't go to pudgy pompous balding militaristic dudes.

They don't want higher bread prices, or lower bread prices, or unchanged bread prices: they want Tea Party bread prices!
posted by dunkadunc at 11:50 AM on March 22, 2010 [1 favorite]


I have to advise you not to get into shootouts with the cops. It never pays.

Well, at least he'll have a shot at getting patched up.
posted by Blazecock Pileon at 11:50 AM on March 22, 2010 [1 favorite]


I'm at least as psyched about this recent victory.

No more public subsidies for the private student loan industry! All Federal student loans will now be administered publicly, not for-profit.
posted by saulgoodman at 11:52 AM on March 22, 2010 [3 favorites]


Artw: Fucking hell, you lot are thin skinned. What's next, pissy remarks if someone refers to something blowing up like the Hindenburg or sinking like the Titanic?

Next up: 500-comment Metatalk over what we can't say about astronauts.
posted by dunkadunc at 11:53 AM on March 22, 2010 [2 favorites]


Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it.
posted by saulgoodman at 11:57 AM on March 22, 2010 [1 favorite]


This is not for no reason. If financial reform is backed up against GOP opposition like this, are you going to tell you when the pollsters call that you are opposed because this or that is still in there?

I haven't been polled about HCR. And actually Yglesias has advocated taking a really hard stance on financial regulation, and being willing to lose. Unlike HCR, no one is going to die if FR doesn't pass. On the other hand, passing a "watered down" FR with lots of bailouts would be political poison.

Yeah, some people in this thread complained about HCR from a liberal side. There also one conservative against it. So what? Those people don't like it!

But I have to ask here, what are you trying to accomplish here? Do you just want to vent? Do you seriously think that you're going to convince any liberals to move over to your side because of your brow beating?

Now obviously, I'm not going to argue that people should take political implications into consideration with their message board comments, but come on. You're not convincing anyone.

Rather then bashing liberals, you should be explaining why this bill advances their agenda, which I think is true. Instead you're just bitching. You've posted way more flighty comments in thread then the HCR haters. RELAX.
It was the minute the GOP's scorched earth tactics came on board. It is like a war. You have to react to your enemy.
The GOP decided to make themselves irrelevant and they succeeded. As I said, the bill is more liberal then it would have been if the republicans had been willing to negotiate. The idea that the GOP killed the Public Option is ridiculous. As far as I can tell, the public option died because unknown democratic senators or congress people told leadership they wouldn't vote for it if it was in there, after being lobbied hard by the insurance industry.
Indoor tanning is now an illegal lifestyle choice.
Well, those people should really switch to sunless tanners. All that UV really fucks up your skin IMO.
posted by delmoi at 11:57 AM on March 22, 2010


There. Let's stop beating around the bush and really get down to the brass tacks of this conversation.
posted by saulgoodman at 11:57 AM on March 22, 2010


If there is a shortage of doctors, blame the AMA.

I could be wrong about this, but I believe the AMA abandoned their doctor rationing program a few years ago, when it became apparent many physicians born in the 1950's and 1960's would be retiring during this decade. Of course if they did, the damage has now been done.

I'm relieved the bill included provisions to expand the industry's workforce. Hope it's enough.
posted by zarq at 11:58 AM on March 22, 2010


Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it.

Flagged as noise. Please take your own advice, or take it to MeTa.
posted by zarq at 11:59 AM on March 22, 2010


I did not say that there is only a $10 hour a job to be had. No no no no no. Nor did I say that your other solution was to do nothing. No no no no no.

Fair enough; given jobs with higher pay, I would of course apply for those first. You appear to suggest that because I am okay with incremental gains toward a goal that this is all I would look for. I'm all about taking big steps, but complaining about the small ones doesn't do anyone any good.

In the same way, if you only have a limited time to make progress, sometimes you have to give up on small gains so you can spend your time working toward making larger gains.

Forgive me, but isn't this in direct opposition to what you were saying? I mean, if all we've got is a short period of time before the loyal opposition takes the reigns again, shouldn't we be trying to get whatever we can- small, medium or large?

This is common sense; it's logic; it's game theory; and it's standard negotiation theory. (If you're always getting every deal you bid on, then your prices are too low...)

Eh, I suppose this is where we disagree, common sense logical game theory or not. If I get every deal I bid on, and I'm happy with what I get and so's the other party, we're both happy.
posted by Pragmatica at 11:59 AM on March 22, 2010


this is the fallacy of the missing middle.

Like Hell it is! I picked a numerical example precisely to avoid that comment!!

The fact is that you can come out with a different best strategy if your numbers are different. For example, suppose you are offered a $90K job immediate, and you think your chances of getting another $100K job are 10%. You'd be foolish then NOT to take the intermediate jon.


We aren't saying "anything is good." We are saying this is a continum and the plan does a whole hell of a lot of good,

And, as I've been clear from the very start, I agree with this.


regardless of your inability to do anything other than say "its not real reform."

I didn't say anything of the sort. I said that we cannot afford to only keep making such small gains after decades of large losses and the likely prospect of more losses again as soon as the Republicans get back into power.


Therefore it is worth it, even if we didn't get a perfect plan

We're back to my original argument, which you seem determined to ignore. While in the short term any gain is better than nothing, in the long term if we keep winning small pots and losing big ones we will lose the game.

This is what? the fourth time I've said this in various terms? and you haven't said one word that convinces me you've even understood what I wrote, let alone provided a rebuttal.
posted by lupus_yonderboy at 12:00 PM on March 22, 2010


For the record, @GOPBoehner is a joke account.
For the record, it's my joke account... :)
posted by shii at 12:01 PM on March 22, 2010 [12 favorites]


Yeah, a Death Star analogy would be a little less offensive, except you can't really see the stormtroopers pointing fingers at each other as they fly apart in little sparkly bits.
posted by condour75 at 12:01 PM on March 22, 2010


Stop it. Stop it. Stop it. Stop it. Stop it. Stop it. Stop it.

Stop what? I honestly have no idea what this comment is in reference to or who it is directed at.
posted by HP LaserJet P10006 at 12:03 PM on March 22, 2010 [1 favorite]


I'm gussing this will be blamed on:

1) Tort claims; and

2) Illegal aliens "burdening" the system.

How do I know? I'm frickin' Nostradamus.
posted by Pollomacho at 11:09 AM on March 22 [5 favorites +] [!]
Scrolling down and scanning as i go, I read this:

will be blamed on:

1) Tiger aliens; and



I had to stop and scroll back up to find out what the alternative to that was.
posted by ServSci at 12:03 PM on March 22, 2010 [2 favorites]


They don't want higher bread prices, or lower bread prices, or unchanged bread prices: they want Tea Party bread prices!

Never has the introduction of Godwin been more appropriate! These guys are looking for emotion only.
posted by Ironmouth at 12:03 PM on March 22, 2010


I'm all about taking big steps, but complaining about the small ones doesn't do anyone any good.

Absolutely it does. We have only a short time to accomplish things. If we waste all the time with small steps, we will have made no significant progress.

I've actually worked many businesses that used this same logical fallacy - who'd cling onto the fact that they continued to "make progress" with increasing sales, despite the fact that it'd be decades before they ever even reached breakeven at the rate they were going. Each time I left and they failed.

At each time I brought forth the argument that we were slowly dying at this rate, and that we needed to do something to accelerate our growth curve, even if it involved aggressively putting in more money, sooner, and then folding if we failed. Each time it was rejected. Each time the company trickled into oblivion over the next few years, costing the investors far more than if they'd made a final attempt to really gain a toehold.
posted by lupus_yonderboy at 12:05 PM on March 22, 2010 [1 favorite]


joedan: Yes, and there's nothing old-school about it. We Latinos are an ethnically diverse group.

yep, that I know. by old school, I meant that under prior race/ethnicity disclosure guidelines, if you were hispanic, you simply checked "white/caucasian", unless you specifically wanted to identify as black, american indian/alaskan native or asian/pacific islander.

most of the latinos I know (from rubio to chino to grifo) didn't "specifically" identify (no value judgment implied) with any of those others, so lacking a better option, they just checked "white," even though they were visibly not what most white north americans consider white, and had the playground scars to prove it.

so, my original snark was, why is Rush Limbaugh planning to move to Costa Rica, a spanish-speaking country with socialized health care? but if the majority population is white criollos, I guess he only has to adjust to the socialist part, and somebody can translate for him. I still think it's weird.
posted by toodleydoodley at 12:08 PM on March 22, 2010


Indoor tanning is now an illegal lifestyle choice.

Clearly, the public will not stand for a 10% tax on the UV tanning beds that their very country was founded on. Sure, UV tanning greatly increases the risk of skin cancer, but what other choice do people have other than to accept the abomination that is spray-on tanning or face the terrible reality of their natural skin color? You can talk all you want about children being eligible for life-saving medical care and whatnot, but was it really worth it if we have to live in a world where an $8 tanning session costs $8.80, or a $40 unlimited monthly tanning plan costs $44 a month? Also, I'm pretty sure that the first thing the Nazis did after they invaded a country was outlaw tanning beds.
posted by burnmp3s at 12:09 PM on March 22, 2010 [26 favorites]


As someone who engages in settlement negotiations almost daily, there is nothing more damning to your cause than taking a negotiating position which is out of step with reality.

This is not a settlement negotiation.

And there is a different school of thought - one the Republicans are very familiar with. When I was in college a hundred years ago, I had a professor who pushed me very hard to become an arbitrator. I took ten or twelve extra classes in labor law and labor relations, as well as hours of personal tutoring by him (he had been a big-league labor negotiator for many years prior to teaching).

Anyhow, negotiating big takes big plans. "Blue sky" bargaining is one way to bargain big. It's simple - make list of everything under the big, blue sky that you want, even stuff you have no hope of getting. Then negotiate away stuff until you end up with what you wanted to begin with.
posted by Benny Andajetz at 12:09 PM on March 22, 2010 [2 favorites]


The thing is we don't know yet, and won't know for many years, whether or not the bill that was just passed turns out to be good step, a bad step, a big step, a small step, stays unchanged, is changed for the better, is changed for the worse, is received well, is received poorly, mostly works, mostly doesn't work, etc. It's early days still.
posted by HP LaserJet P10006 at 12:10 PM on March 22, 2010 [3 favorites]


Stop what? I honestly have no idea what this comment is in reference to or who it is directed at.

Oh, I was just distilling the back and forth arguments to their essence, not trying to get involved in one. Meant my second comment to clear that up.
posted by saulgoodman at 12:13 PM on March 22, 2010


We're back to my original argument, which you seem determined to ignore. While in the short term any gain is better than nothing, in the long term if we keep winning small pots and losing big ones we will lose the game.

I'm saying, over and over again, that this isn't a small pot, dude. I get your argument, I just refuse to agree to your premises. Its quite simple, actually.

regardless of your inability to do anything other than say "its not real reform."

I didn't say anything of the sort. I said that we cannot afford to only keep making such small gains after decades of large losses and the likely prospect of more losses again as soon as the Republicans get back into power.


I quote you:

Any form of real progress is "out of step with reality".

That would be you, saying it isn't "real progress" to pass this bill. What else could it mean.

We're expanding the war in Afghanistan. That's negative progress.

Some people, like myself, feel that we have to eliminate that threat once and for all. Unlike Iraq, I think we can all agree that letting that shit fester last time led to some people flying some planes into some buildings. So its, just your opinion.


Kucinich came out for the bill. To my knowledge, none of the 34 Democrats against the bill were against it b/c it was not progressive enough.

Lynch.

Now let's be clear here. My purpose is to give everyone my position, which is that while the GOP is in scorched earth mode, combining together instead of attacking the bill that made it is going to be our best strategy for the months ahead--with the huge changes that are coming. Finanical Reform, DADT all of that. Because it just isn't on all of this. When Obama announced the repeal of DADT, people here started getting pissed because apparently the US Code sections involved were just so easily changed, they could see no reason why all of it couldn't be done last week. So this is going to affect battles going forward.
posted by Ironmouth at 12:13 PM on March 22, 2010


Warning, this will be long.

I work at a large hospital, my job is to work with the insurance companies of the patients who are admitted on an emergency basis. Before that, I was on the elective side of it (working with insurance for patients coming in for pre-scheduled procedures). I've been doing this for 9 years now and some of the cases I have seen, with insurance companies pulling fast ones on patients, have actually brought me to tears, both at work and at home.

I was upset that the public option didn't make it. It was disappointing, but I understand that a certain set of circumstances made it so that, in order to get *something* get enough votes to pass, it had to be dropped. I'm not surprised at the Republican Wall of Resistance, but I continue to be shocked at the Democrats who helped cause it's demise.

However, I think what we have here is a good start towards helping to reign in some of the crass abuses of the health insurance industry. Examples:

1. Ending lifetime maximums (LTM's) : most insurance companies have a maximum amount they will pay on your claims before ending your policy. The most common number is $2 million. For someone with chronic illnesses or who got in a really bad accident, you can see that LTM reached faster than you'd think. I have seen patients with $1 million LTM's reach that number in one hospital stay. What happens to those people after their policy gets yanked? There's no way they are getting accepted on another plan, yet here they are, still sick. Which brings me to...

2. Eliminating denials of coverage due to pre-existing conditions: This helps the millions of people who can be denied for having, you know, been alive and had something happen to them healthwise. I've seen policies that consider pregnancies and c-sections to be "pre-existing conditions". This would have helped the kid who came to see one of our cancer specialists 3 days after his policy went into effect. His parents got a confirmation of his cancer diagnosis on that day. However, his insurance company refused to pay for chemo because his cancer was a pre-ex condition. Why? Because the day before his policy went into effect, his parents took him to the ER for certain symptoms, which were diagnosed on that 3rd day as cancer. So because the kid had pain before the 1st day of coverage, that was enough to deny his chemo. This is not an unusual situation.

3. Coverage for children up to age 26: Right now you can cover your kids thru 26 if they are students. Now such a caveat is eliminated. People in that age group are very likely to be uninsured, especially given the state of the economy. Being on the emergency side of admissions, I can tell you that there are a lot of 20somthings who could nto get insurance through work, or could nto afford to get their own policies, and suddenly they find themselves sick, or in accidents. This is going to make a huge difference in our ER's because it helps expans the pool of insured people.

I could go on, but I'm already in tl;dr territory. There are lots of good things to look forward to, whether it be in the stuff that goes into effect this year, or 4 years from now. I understand the disappointments of things that we could not include. But I can't tell you how disheartening it is to read the complaints about hwo this is bad because it's doesn't have a public option, and how this was a waste of time, etc etc. This makes me hopeful, because as people start to receive these new benefits, they will get used to them being status quo, and will be pretty upset if some other administration down the line tries to mess with them. It's just hard to understand the benefits because a lot of people have been fortunate enough to not see the sorry state health insurance is in.

And by no means this this mean we have to stop fighting for the public option.
posted by DrGirlfriend at 12:15 PM on March 22, 2010 [76 favorites]


toodleydoodley: so, my original snark was, why is Rush Limbaugh planning to move to Costa Rica, a spanish-speaking country with socialized health care? but if the majority population is white criollos, I guess he only has to adjust to the socialist part, and somebody can translate for him. I still think it's weird.

It is weird, but oh well. Speaking of Rush's move, anyone who wants to chip in to buy him a plane ticket can donate here.
posted by joedan at 12:15 PM on March 22, 2010


So this is going to affect battles going forward.

I assume by "this" you mean progressives for whom Obama's changes are not progressive or substantial enough. But again I think a far bigger problem is the Blue Dog, "centrist" Dems who will continue to side with Republicans in blocking reform. In other words, I think your emphasis is misplaced. Progressive bloggers (and btw Markos of dailykos supported this bill) are not the problem.
posted by HP LaserJet P10006 at 12:19 PM on March 22, 2010


Absolutely it does. We have only a short time to accomplish things. If we waste all the time with small steps, we will have made no significant progress.

And what would you suggest in place of what was done? One and a quarter years in, one hell of a slog, and we have this. It's a victory, and the size of the victory is arguable, but I'm not sure what else was possible at this time on this issue.
posted by Pragmatica at 12:19 PM on March 22, 2010


Fine flag it. I would probably have done the same. I'm just tired of having a debate about the health care reform that talks about everything but what's specifically in the health care reform. I tried to get some specific comment from critics on a summary of the provisions that actually passed up-thread, but none of the people who really, really hate the reform seems to care enough about what's actually in it to explain to me why I should hate these things. And it seems to me we're just arguing to argue.
posted by saulgoodman at 12:19 PM on March 22, 2010


The thing is we don't know yet, and won't know for many years

Unfortunately, that's not how life works - we have to base our next steps on our best information right now, we can't just wait around for years. The bill is set up so much of it doesn't even start until after the next electoral cycle but one!
posted by lupus_yonderboy at 12:19 PM on March 22, 2010


so, my original snark was, why is Rush Limbaugh planning to move to Costa Rica, a spanish-speaking country with socialized health care

You know who else used to be Socialist and was friendly to Spanish-speaking countries in the Americas? Russians.

Russians. Rush-ians. IT ALL MAKES SENSE!

I WANT TO BELIEVE!
posted by mazola at 12:21 PM on March 22, 2010


Ezra Klein on "the five most promising cost controls in the healthcare bill"
posted by Pater Aletheias at 12:23 PM on March 22, 2010 [6 favorites]


we can't just wait around for years.

I was not talking about the politics or party strategy, I was talking about the practical implementation of any bill of this scope: it will be a long, long time before anyone not looking to score political points can actually properly and objectively analyze the degree to which this thing works, needs tinkering, etc.
posted by HP LaserJet P10006 at 12:24 PM on March 22, 2010


Also, I'm pretty sure that the first thing the Nazis did after they invaded a country was outlaw tanning beds.

Speaking of vich, when do ve start rounding up ze old peeple for ze death panels?
posted by Blazecock Pileon at 12:25 PM on March 22, 2010


And what would you suggest in place of what was done?

Single payer - the overwhelming favorite of all other successful health systems throughout the world.

Failing that, the public option - the favorite of the American public, and the only thing that actually allow us to cut costs absent single payer.

The glacially slow pace of adoption is also very lame, particularly considering how small the actual changes are. Perhaps there are good reasons why this can't all be done in a couple of years, but heck, I don't see it - we set up Homeland Security really fast and the government side of the new bill is a tiny percentage of the size of DHS.

I'll bet if you were honest, you could have told me exactly what I was going to say...
posted by lupus_yonderboy at 12:26 PM on March 22, 2010 [1 favorite]


Many have been concerned that there will be a shortage of primary care doctors to deal with the influx of new patients.

So we should be against healthcare reform becuase more people will get access to healthcare?


This absolutely blows my mind everytime I see it, and I saw it this morning to see how faux news was spinning things.

"There won't be enough doctors!"

Critical thinking fail.
posted by Big_B at 12:26 PM on March 22, 2010


The bill is set up so much of it doesn't even start until after the next electoral cycle but one!

But lupus_yonderboy, that's just demonstrably not true. You're repeating one of the Republican's distortions of fact as if it were fact. Again, from up-thread:
o In 2010, small businesses that choose to offer coverage will begin to receive tax credits of up to 35 percent of premiums to help make employee coverage more affordable.

o In 2010, adults who are uninsured because of pre-existing conditions will have access to affordable insurance through a temporary high-risk pool.

o This bill starts to close the Medicare Part D doughnut hole in 2010 by providing a $250 rebate to Medicare beneficiaries who hit the gap in prescription drug coverage. And beginning in 2011, the bill institutes a 50 percent discount on prescription drugs in the doughnut hole.

o Starting this year, new private plans will be required to provide free preventive care: no co-payments and no deductibles for preventive services. And beginning Jan. 1, 2011, Medicare will do the same.

o In 2010, this bill will provide help for early retirees by creating a temporary re-insurance program to help offset the costs of expensive premiums for employers and for retirees ages 55-64.

Under health reform, Americans will see an immediate expansion of coverage.

o This year, children with pre-existing conditions can no longer be denied health insurance coverage. The bill outlaws that practice for new health plans as well as grandfathered group plans. Moving forward, no insurance company can deny a child coverage based on his or her health.

o This year, new health care plans and select grandfathered plans will allow young people to remain on their parents’ insurance policy until their 26th birthday.


o This year, insurance companies will be banned from dropping people from coverage when they get sick, and they will be banned from implementing lifetime caps on coverage. This year, restrictive annual limits on coverage will be banned for new plans and grandfathered group health plans. Under health reform, Americans will be ensured access to the care they need.

o The bill increases funding for community health centers so that nearly twice the number of patients can be treated in their community health centers over the next five years. The funding begins in the next fiscal year.

o The health reform bill will increase the number of primary care doctors, nurses, nurse practitioners and physician assistants through new investments. This funding takes effect in the next fiscal year.

Health reform will immediately curb some of the worst insurance industry practices and strengthen consumer protections.

o Beginning this year, this bill creates a new, independent appeals process that ensures consumers in new private plans have access to an effective process to appeal decisions made by their insurer.

o Starting Jan. 1, 2011, insurers in the individual and small group market will be required to spend 80 percent of their premium dollars on medical services. Insurers in the large group market will be required to spend 85 percent of their premium dollars on medical services. Any insurers that don’t meet those thresholds will be required to provide rebates to their policyholders.

o This year, discrimination based on salary will be outlawed. New group health plans will be prohibited from establishing any eligibility rules for health care coverage that discriminate in favor of higher-wage employees.

o This bill holds insurance companies accountable for unreasonable rate hikes. Starting in 2011, it helps states require insurance companies to submit justification for all requested premium increases. Any company with excessive or unjustified premium increases may not be able to participate in the new health insurance exchanges.

o Beginning this fiscal year, this bill provides funding to states to help establish offices of health insurance consumer assistance in order to help individuals in the process of filing complaints or appeals against insurance co
posted by saulgoodman at 12:26 PM on March 22, 2010 [4 favorites]


saul: I'm for all the things you discussed, and this bill is definitely a positive step. It's just a tiny step and its tiny gains will be completely eaten up as long as health care costs continue to increase in the fashion they have been for the last couple of decades.
posted by lupus_yonderboy at 12:28 PM on March 22, 2010


The bill is set up so much of it doesn't even start until after the next electoral cycle but one!

Single payer - the overwhelming favorite of all other successful health systems throughout the w


How long do you think it takes to get a single-payer system set up? How long does it take before people can determine whether or not it’s working? Any system with financial ramifications takes years to sufficiently analyze, which will be done. As for concrete, tangible benefits that take place this year – see saulgoodman’s list upthread.
posted by Think_Long at 12:29 PM on March 22, 2010


The glacially slow pace of adoption is also very lame, particularly considering how small the actual changes are. Perhaps there are good reasons why this can't all be done in a couple of years, but heck, I don't see it - we set up Homeland Security really fast and the government side of the new bill is a tiny percentage of the size of DHS.

Setting up brand new insurance pools, expanding Medicaid, and significantly altering revenue sources for current insurance companies takes time to fund, staff, and coordinate. Could we have done it in 2 years instead of 4? Maybe, but would it have been done correctly? I'm not sure that that's the case.
posted by DrGirlfriend at 12:29 PM on March 22, 2010 [1 favorite]


Wow. I can't believe they actually used this as a stepping stone as to how great they are (68% rate hike great).

Then again, yes I can.
posted by stormpooper at 12:31 PM on March 22, 2010


If we waste all the time with small steps, we will have made no significant progress.

See, here's the deal with small steps. When we take big steps we lose, period. You overstep your bounds and you get ousted and your opponent gets to start pushing their agenda. The Republicans are already claiming that this little half step is too far. You go for universal socialized medicine at the gate and you get two years tops. You go for this wiff towards the less right and show some progress, you (hopefully) get four. You make some more progressive baby steps you get six or eight. You control the field and play your opponents against themselves you might get 12. If you drop the ball your opponent gets 16 or more. That's the game in this town.

we set up Homeland Security really fast and the government side of the new bill is a tiny percentage of the size of DHS

DHS wasn't created from thin air, it was a consolidation of existing agencies. It was also staffed mostly with contractors (shocking in a Republican government I know).
posted by Pollomacho at 12:31 PM on March 22, 2010


hah, I posted that last comment BEFORE you reposted, saulgoodman! (I looked up to your first post...)

And you're right that there are more advantages in the next two years than I'd realized.

Again - this is a useful bill - but I'm also realistic. I don't see this bill really fixing the health care system, and I don't expect to see another health bill of any magnitude for at least ten years.
posted by lupus_yonderboy at 12:33 PM on March 22, 2010


saul: I'm for all the things you discussed, and this bill is definitely a positive step. It's just a tiny step and its tiny gains will be completely eaten up as long as health care costs continue to increase in the fashion they have been for the last couple of decades.

But will you admit that your statement above that the bill only does one thing in this election cycle is completely baseless? Because it is. It does all the things enumerated in my comment just in the next year or two. Please don't pass along the untrue Republican talking point that it doesn't, because that's part of their strategy for creating popular opposition to the reform, in hopes of fueling a backlash going into the midterms.
posted by saulgoodman at 12:33 PM on March 22, 2010


I'll bet if you were honest, you could have told me exactly what I was going to say...

No, those things are honestly surprising to me - you have spoken so much about negotiations and game theory that I'd assumed you understood the likelihood of actually getting single payer or the public option was virtually nil. The interests entrenched against such a thing are incredibly powerful, and I believe they're going to have to be taken out by degrees, because a direct assault would end up looking a lot like a class war.

I thought you were going to bring up other promises that Obama has vacillated or downright done a turnabout on, and I was going to say we've still got about two years and nine months to deal with some of those...
posted by Pragmatica at 12:34 PM on March 22, 2010


And what would you suggest in place of what was done? One and a quarter years in, one hell of a slog, and we have this.

Pragmatica, he would have gotten Joe Stupak to cast the deciding vote on a single payer plan with no abortion restrictions, duh. He would have negotiated for it! Like when you play Go! You either put in more money and aggressively bend the cost curve, or...er...fold. Who is to say which might have happened?!?! Incrementalism, except for every other piece of progressive legislation in the history of the country, doesn't work! Remember when the 1964 Civil Rights Act was a thorough failure and now we have slavery again? Too bad about that! WHY DIDN'T YOU NEGOTIATE HARDER, LBJ!

GODDAMNIT HERE I AM KWINING ALL OVER EVERYWHERE AGAIN, I APOLOGIZE
posted by Kwine at 12:34 PM on March 22, 2010


hah, I posted that last comment BEFORE you reposted, saulgoodman! (I looked up to your first post...)

Oops--I should have previewed. Thank you. That's all I ask.
posted by saulgoodman at 12:35 PM on March 22, 2010


lupus_yonderboy: saul: I'm for all the things you discussed, and this bill is definitely a positive step. It's just a tiny step and its tiny gains will be completely eaten up as long as health care costs continue to increase in the fashion they have been for the last couple of decades.

You might have missed it when it was posted upthread, lupus, but you really should read this New Yorker article, How the Senate bill would contain the cost of health care.

The cost problem, people have come to realize, threatens not just our prosperity but our solvency.

So what does the reform package do about it? Turn to page 621 of the Senate version, the section entitled “Transforming the Health Care Delivery System,” and start reading. Does the bill end medicine’s destructive piecemeal payment system? Does it replace paying for quantity with paying for quality? Does it institute nationwide structural changes that curb costs and raise quality? It does not. Instead, what it offers is . . . pilot programs.

This has provided a soft target for critics. “Two thousand seventy-four pages and trillions of dollars later,” Mitch McConnell, the Senate Minority Leader, said recently, “this bill doesn’t even meet the basic goal that the American people had in mind and what they thought this debate was all about: to lower costs.” According to the Congressional Budget Office, the bill makes no significant long-term cost reductions. Even Democrats have become nervous. For many, the hope of reform was to re-form the health-care system. If nothing is done, the United States is on track to spend an unimaginable ten trillion dollars more on health care in the next decade than it currently spends, hobbling government, growth, and employment. Where we crave sweeping transformation, however, all the current bill offers is those pilot programs, a battery of small-scale experiments. The strategy seems hopelessly inadequate to solve a problem of this magnitude. And yet—here’s the interesting thing—history suggests otherwise.

posted by joedan at 12:35 PM on March 22, 2010


(...I predict the Republicans are going to have a serious case of buyer's remorse on the "Obamacare" label.)

My formerly Republican mother and I were watching the health care debate last night

Republican Rep. (derisively): blah blah Obamacare blah blah
Sally (sarcastically): How nice.
Sally's Mom (sincerely): It is so nice of them to name the bill after Obama in recognition of his hard work!
posted by sallybrown at 12:35 PM on March 22, 2010 [13 favorites]


I don't expect to see another health bill of any magnitude for at least ten years.

Well hopefully any positive, substantive changes can be added to the existing bill, rather than require starting from scratch. I remain unsure about if an how that will be the case, so perhaps someone here--who sees this current bill as potentially morphing into a more progressive bill--might spell out the specifics of a possible scenario whereby such changes occur?
posted by HP LaserJet P10006 at 12:38 PM on March 22, 2010


because a direct assault would end up looking a lot like a class war

The insurance companies have been waging class war for years. Real class war, the kind where people die, not the kind you're being alarmist about here where very rich people have to pay a very little bit more in taxes.
posted by enn at 12:39 PM on March 22, 2010 [2 favorites]


*sings* "President Obama once did healthcare legislation in Washington just to watch a Glen Beck cry. "
posted by happyroach at 12:39 PM on March 22, 2010 [1 favorite]


Again - this is a useful bill - but I'm also realistic. I don't see this bill really fixing the health care system, and I don't expect to see another health bill of any magnitude for at least ten years.

Fair enough, but maybe if this one comes to be viewed as a success, all the pols will soon be jumping aboard the bandwagon, hoping to make a name for themselves through health care reform.

If taking on these issues comes to be viewed as paying political dividends, then some more reluctant lawmakers in congress are likely to try to cash in on the trend.
posted by saulgoodman at 12:39 PM on March 22, 2010


When we take big steps we lose, period.

We are speaking in a different language here. When I refer to "steps" they are always positive. By definition, taking "big steps forward" is positive, and is equivalent to a big win.

I think what you mean to say is, "When we attempt to make big steps, we lose every time."

I agree - but I'm also pointing out that our opposition takes big steps and scores big wins. If it's really the case that we can only take small steps, then we will lose.

I'd also note that in the past our side has made huge gains - the New Deal, the 60s - so I don't see why it's impossible.
posted by lupus_yonderboy at 12:40 PM on March 22, 2010


How long do you think it takes to get a single-payer system set up?

Canada did it in four years, by steps.
posted by Blazecock Pileon at 12:40 PM on March 22, 2010 [4 favorites]


no, no saul: I mistyped, I meant I should have previewed, or rather, I was reading your message upstream while you were pasting it!
posted by lupus_yonderboy at 12:42 PM on March 22, 2010


Sorry I'm late. How's everything going?













Oh.
posted by grubi at 12:43 PM on March 22, 2010 [1 favorite]


The DOW, NASDAQ and healthcare stocks are all up today. Doesn't the market realize Armageddon is coming?
posted by caddis at 12:44 PM on March 22, 2010


So, anyway, when does Lieberman's head get paraded through the streets of Washington on a Death Panel pike? Everyone can enjoy that part.
posted by Artw at 12:45 PM on March 22, 2010 [5 favorites]


The glacially slow pace of adoption is also very lame, particularly considering how small the actual changes are. Perhaps there are good reasons why this can't all be done in a couple of years, but heck, I don't see it -

Blame the founders. They set up the Senate to brake the House and they put in that the Senate, House and President all have to agree before getting anything done. they also put in Filibuster in the first years of the Republic.

We are a slow system by design.
posted by Ironmouth at 12:45 PM on March 22, 2010 [1 favorite]


The DOW, NASDAQ and healthcare stocks are all up today. Doesn't the market realize Armageddon is coming?

the losses were already priced in and now we have certainty.
posted by Ironmouth at 12:46 PM on March 22, 2010


I'd also note that in the past our side has made huge gains - the New Deal, the 60s - so I don't see why it's impossible.

But even when pushing through the New Deal, FDR reportedly decided not to attempt to tackle health care reform due to the insurmountable political challenges it presented. It was excluded from the New Deal so that the New Deal could get through.

Let me repeat that: FDR dropped any attempt at HCR in order to get the New Deal passed. Doesn't that tell you something about how difficult this particular issue has historically been?

Here's another piece from NPR on the historical significance of this legislation.
posted by saulgoodman at 12:49 PM on March 22, 2010 [7 favorites]


How long do you think it takes to get a single-payer system set up?

Canada did it in four years, by steps.


Huh? four years?

It was not until 1946 that the first Canadian province introduced near universal health coverage. Saskatchewan had long suffered a shortage of doctors, leading to the creation of municipal doctor programs in the early twentieth century in which a town would subsidize a doctor to practice there. Soon after, groups of communities joined to open union hospitals under a similar model. There had thus been a long history of government involvement in Saskatchewan health care, and a significant section of it was already controlled and paid for by the government. In 1946, Tommy Douglas' Co-operative Commonwealth Federation government in Saskatchewan passed the Saskatchewan Hospitalization Act, which guaranteed free hospital care for much of the population. Douglas had hoped to provide universal health care, but the province did not have the money.

In 1950, Alberta created a program similar to Saskatchewan's. Alberta, however, created Medical Services (Alberta) Incorporated (MS(A)I) in 1948 to provide prepaid health services. This scheme eventually provided medical coverage to over 90% of the population.[30]

In 1957, the federal government passed the Hospital Insurance and Diagnostic Services Act to fund 50% of the cost of such programs for any provincial government that adopted them. The HIDS Act outlined five conditions: public administration, comprehensiveness, universality, portability, and accessibility. These remain the pillars of the Canada Health Act.

By 1961, all ten provinces had agreed to start HIDS Act programs. In Saskatchewan, the act meant that half of their current program would now be paid for by the federal government. Premier Woodrow Lloyd decided to use this freed money to extend the health coverage to also include physicians. Despite the sharp disagreement of the Saskatchewan College of Physicians and Surgeons, Lloyd introduced the law in 1962 after defeating the Saskatchewan Doctors' Strike in July.

Medical Care Act
The Saskatchewan program proved a success and the federal government of Lester B. Pearson, pressured by the New Democratic Party (NDP) who held the balance of power, introduced the Medical Care Act in 1966 that extended the HIDS Act cost-sharing to allow each province to establish a universal health care plan. It also set up the Medicare system. In 1984, the Canada Health Act was passed, which prohibited user fees and extra billing by doctors. In 1999, the prime minister and most premiers reaffirmed in the Social Union Framework Agreement that they are committed to health care that has "comprehensiveness, universality, portability, public administration and accessibility."


The only people who did it easy and quick was the German Empire in 1883, but that was a conservative bringing the measure forward.
posted by Ironmouth at 12:51 PM on March 22, 2010 [1 favorite]


the losses were already priced in and now we have certainty.

Do you have a cite for that? I think the cause in the short-term for healthcare stocks rising today remains debatable, at the very least.
posted by HP LaserJet P10006 at 12:51 PM on March 22, 2010


So, anyway, when does Lieberman's head get paraded through the streets of Washington on a Death Panel pike?

After he's voted out of office, but before the ban on pre-existing conditions kicks in.
posted by DrGirlfriend at 12:53 PM on March 22, 2010


joedan: I saw that article when it came out, it's most interesting.

Again, the issue is that none of these interesting but minor cuts address the elephant in the room - that at least one health dollar in three goes to insurance companies, people who neither directly provide you health care nor support or organize those who do.

You've probably guessed from my leftist views that I'm hardly an invisible hand sort of guy. But pragmatically, you don't want to be in the position of trying to force markets against natural economic forces.

There are three parties involved in the current system - the People, health care providers and the insurance companies. Two of the parties have a vested interest in keep prices as high as they can - and insurers also have a vested interest in extracting as much money as they can from the whole process, whereas the People individually have very little ability to keep prices down.

It seems like this system has to work out with the People losing out!

The government is intending to fix this by paying people to become experts on this system and simply set prices "fairly" - it seems like a bad place to be and it will be a particularly bad place to be if the downturn continues and health care actually does get rationed. They are standing in the way of a natural economic force - how can it go well for them?

How much simpler would it be if The People could simply bargain collectively with the heath care providers! This is what they do in every other country I've ever lived in. With just two parties and on a fairly even footing, the natural economic equilibrium of buyer vs seller serves to stabilize prices, and also make them realistic.
posted by lupus_yonderboy at 12:57 PM on March 22, 2010


Canada did it in four years, by steps.

Huh? four years?



Well not four sequential years...
posted by mazola at 12:58 PM on March 22, 2010 [2 favorites]


Do you have a cite for that?

What else could it be? The market is omniscient!
posted by Jimmy Havok at 1:00 PM on March 22, 2010


I agree - but I'm also pointing out that our opposition takes big steps and scores big wins. If it's really the case that we can only take small steps, then we will lose.

I'd also note that in the past our side has made huge gains - the New Deal, the 60s - so I don't see why it's impossible.


They lose too. Thus the DNC controls the Hill and the White Houose. But you also have to reverse the equasion; if your opponent oversteps you get to return with a fury. We got the new deal because of the Great Depression. We have the Hill and Whitehouse because of how terrible the Contract with America ideologues and 8 years of Bush were.
posted by Pollomacho at 1:00 PM on March 22, 2010


I remain unsure about if an how that will be the case, so perhaps someone here--who sees this current bill as potentially morphing into a more progressive bill--might spell out the specifics of a possible scenario whereby such changes occur

Sure! Once the exchanges are up and running, here are some smaller pieces of legislation that could make things more progressive:

*Allow undocumented immigrants to buy coverage in the exchanges regardless of citizenship status (the exclusion of these folks is the major reason this legislation won't result in "universal" health care)

*Increase the FMAP in Medicaid for all beneficiaries, not just the newly eligible under this legislation (that is, take steps to federalize Medicaid more than it already is, so that there's less variability in the benefits that a poor person in Mississippi gets vs. a poor person in New York)

*Revoke the right of states to disallow abortion coverage in their exchange

Those would be my major improvements on this bill (and as I explained upthread, my current thinking is that the abortion coverage issue will become less salient to abortion availability as we shift away from our current payment methods). Just about the only thing on my wish list that isn't possible at this point is to have a single federal exchange rather than state-based or regional exchanges.

I'm unconvinced that a public option will have much effect on actual premium levels--which is why I'm somewhat agnostic on whether it's a good or bad thing that they were dropped--but it's worth noting that if some future Congress had the votes for a public option, it would be relatively trivial to pass that as a piece of stand-alone legislation: there is nothing in the current bill that would prevent a public option from being offered on the exchanges in the future.
posted by iminurmefi at 1:00 PM on March 22, 2010 [1 favorite]


The DOW, NASDAQ and healthcare stocks are all up today. Doesn't the market realize Armageddon is coming?

the losses were already priced in and now we have certainty.


The Dow was actually around the same level as the start of the day today on Jan 19th 2010 (Hello Scott Brown) and went down from there precipitously (when health care reform was "dead"). I'm not computing your argument here.
posted by dig_duggler at 1:01 PM on March 22, 2010


We are speaking in a different language here. When I refer to "steps" they are always positive. By definition, taking "big steps forward" is positive, and is equivalent to a big win.

I think where we are really differing is on whether or not this is a big step. I happen to think it is titanic, but you seem to think there was a whole lot of potential out there.

And there is a different school of thought - one the Republicans are very familiar with. When I was in college a hundred years ago, I had a professor who pushed me very hard to become an arbitrator. I took ten or twelve extra classes in labor law and labor relations, as well as hours of personal tutoring by him (he had been a big-league labor negotiator for many years prior to teaching).

uh, an arbitrator decides a matter. a mediator mediates. And I've negotiated those labor contracts you took some classes in. I'm a union lawyer, after all. And just starting out from a blue-sky point, in my personal, actual, non-theoretical experience, gets you a better settlement in the end. Because they can't point to your pie-in-the-sky and call bullshit.

That said, the battle was lost, the side of corporatism/fascism has won,

Let's get our terms straight. The GOP are not fascists, nor corporatists. These are terms from the 1920s-'30s that are totally misused today. A facist does not believe in representative government and believes in a corporatist state--where a dictator dictates outcomes between represenatives of business, labor and social entities. Today's GOP has no idea what those things mean.

These guys are just plain reactionary conservatives. We don't need to Godwin out everyone the first opportunity we get.
posted by Ironmouth at 1:01 PM on March 22, 2010 [1 favorite]


I don't see this bill really fixing the health care system, and I don't expect to see another health bill of any magnitude for at least ten years.

The alternative was nothing, and no health bill of any magnitude for at least ten years. This is better, or at least less bad.
posted by one more dead town's last parade at 1:02 PM on March 22, 2010 [1 favorite]


One other point. The way to get the Blue dogs to vote for you is to attack the GOP to their right. That gives them the breathing room they need to vote for us. I think the problem was that the strategy was to trade with the Blue Dogs instead of putting tough votes in front of senate GOP moderates, which is what should have been done. Because if one of them cracks, the Blue Dogs have the room to vote with the Dems.
posted by Ironmouth at 1:03 PM on March 22, 2010 [1 favorite]


We are a slow system by design.

Perhaps you misunderstood what I meant.

It's well-known that the US is designed so that legislation is slow to pass. But there's nothing in the Constitution as far as I can see that forces the United States to be slow to act once legislation has been passed - quite the reverse might be argued if you pointed to how strong the President's role is in this regard.

Certainly there are numerous examples of the United States executing its decisions quickly, from the New Deal to the Space Race to the Iraq War. I don't remember any great delay between the Civil Rights Act being passed and its becoming effective, nor between Bush's getting the Woo judgements and starting up torture.

I was not complaining about the slow pace to pass the legislation, but rather the slow timetable once passed. I don't see anything at all in the Constitution or in US history that's relevant.
posted by lupus_yonderboy at 1:05 PM on March 22, 2010


that at least one health dollar in three goes to insurance companies, people who neither directly provide you health care nor support or organize those who do

Well, I'm totally going to keep playing my broken record here. I'm pretty sure these provisions explicitly do exactly what you say the bill doesn't do:

o Starting Jan. 1, 2011, insurers in the individual and small group market will be required to spend 80 percent of their premium dollars on medical services. Insurers in the large group market will be required to spend 85 percent of their premium dollars on medical services. Any insurers that don’t meet those thresholds will be required to provide rebates to their policyholders.

If 1 out of every three dollars spent on insurance goes to the insurance company currently as you suggest, that means 33% of the dollars now go to the insurance companies rather than to treatment. The cap at 80% means that only 20% of the dollars can now go to the insurance companies on the individual market; the cap at 80% means that only 15% can go to the insurance companies on the group market (which is where most people are anyway). Once the exchanges are established, I don't know what limits there will be, but presumably, participation in the exchanges will require satisfying similar or more stringent requirements.

If you're right that 1 out of every 3 dollars currently goes to the insurance companies, then this is major progress.

Also, this is great:

o Beginning this year, this bill creates a new, independent appeals process that ensures consumers in new private plans have access to an effective process to appeal decisions made by their insurer.
posted by saulgoodman at 1:08 PM on March 22, 2010 [1 favorite]


One other point. The way to get the Blue dogs to vote for you is to attack the GOP to their right. That gives them the breathing room they need to vote for us. I think the problem was that the strategy was to trade with the Blue Dogs instead of putting tough votes in front of senate GOP moderates, which is what should have been done. Because if one of them cracks, the Blue Dogs have the room to vote with the Dems.

I agree, but in as razor thin a margin as we have right now, you've always got to support your own caucus. You cannot give ANY GOP seats a take-home. The far left is safe territory for the DNC caucus, the center/right is not and needs all the take-homes they can get come November.
posted by Pollomacho at 1:09 PM on March 22, 2010


Ironmouth, this is what I interpreted to mean, by saying Canada as a whole:

The result was that the Progressive Conservative government of John Diefenbaker, who also happened to represent Saskatchewan, introduced and passed (with all-party approval) the Hospital Insurance and Diagnostic Services Act of 1957. This shared the costs of covering hospital services. By the start date (July 1, 1958) five provinces—Newfoundland, Manitoba, Saskatchewan, Alberta, and British Columbia - had programs in place which could receive the federal funds. By January 1, 1961, when Quebec finally joined, all provinces had universal coverage for hospital care.

It appears to have taken four years, from 1957 to 1961, to extend coverage across the country. It looks like there are other aspects of coverage that were implemented from 1962 onwards, though.
posted by Blazecock Pileon at 1:10 PM on March 22, 2010


Seriously, for people bitching about how hot it sometimes gets in these threads, people here are really debating, really putting answers out there, really citing real facts. This is what makes this site so great! It is perfect!
posted by Ironmouth at 1:10 PM on March 22, 2010 [6 favorites]


I was not complaining about the slow pace to pass the legislation, but rather the slow timetable once passed. I don't see anything at all in the Constitution or in US history that's relevant.

Well, don't I feel dumb. I think to answer this question is the ability to claim fiscal responsibility. You dump a trillion dollar program on the electorate during a recession and they are going to shit their pants and we'll have President Palin pushing Glen Beck for Secertary of State in no time. You dump it incrementally and it doesn't look like you are dumping it on them.
posted by Pollomacho at 1:12 PM on March 22, 2010


"The alternative was nothing, and no health bill of any magnitude for at least ten years."

I fail to understand why everyone seems to think anyone would be proposing "doing nothing".

The alternative to a weak bill isn't nothing at all, it's a strong bill.

A stronger health bill which included provisions like the public option which had shown to be very popular amongst Americans might have done even better on votes than what we have. Americans aren't really very fond of nuanced thinking, compromises and the like - they like strength and simplicity.

Regardless, I've made pretty ironclad arguments that if unless you are willing to accept some level of risk, you will only make tiny gains, and thus lose the battle in the long term.

By always making the slow choice of accepting tiny, low-risk gains, you doom yourself to lose in the long-term.
posted by lupus_yonderboy at 1:15 PM on March 22, 2010


This is what makes this site so great! It is perfect!

metafilter: the enemy of the good.

**

Seriously, though: if the bill had not passed, certain folks here would be blaming "unrealistic Naderites" or what have you, and now that the bill did pass, those same folks are blaming "unrealistic Naderities" and what have you, for...for...for what exactly? The bill passed, stop gloating.
posted by HP LaserJet P10006 at 1:16 PM on March 22, 2010


I don't remember any great delay between the Civil Rights Act being passed and its becoming effective

Well, which Civil Rights Act do you mean? Because legislatively, the Civil Rights Act of 1875 covered everything. But it was wiped out effectively first by the Civil Rights Cases (1883) and "separate but equal" in Plessy v. Ferguson

Not only that but Brown v. Board was in 1954. Only with Swann in 1971 was it given teeth.

Admittedly a very liberal court found in Heart of Atlanta Motel (1964) relatively quickly that the civil rights act provisions were constitutional. But that has been the exception in history.
posted by Ironmouth at 1:17 PM on March 22, 2010


You keep saying that, but didn't it work in Massachusetts?

I ask this because I honestly don't know: Did it really, in fact, work in Massachusetts? I mean, did they ever fix this problem?

A bumrush of newly insured and a lack of GPs was the issue that worried me a couple years ago. Because then, it seemed, that nobody was really happy about having to pay for health care that nobody could use efficiently. And once the patient did finally get to the doctor, I would imagine they'd have had like 8 minutes of actual face-time.

Still a problem? (Really asking, please don't eat me.)
posted by functionequalsform at 1:17 PM on March 22, 2010


Seriously, though: if the bill had not passed, certain folks here would be blaming "unrealistic Naderites" or what have you, and now that the bill did pass, those same folks are blaming "unrealistic Naderities" and what have you, for...for...for what exactly? The bill passed, stop gloating.

What I'm saying is that until the GOP stops with its scorched earth strategy, we should bind together more tightly and not give them future opportunities to argue that "the country is against" the dems, when some want more and some want less or none.
posted by Ironmouth at 1:19 PM on March 22, 2010 [1 favorite]


Americans aren't really very fond of nuanced thinking, compromises and the like - they like strength and simplicity.

At least that's what we've been told by (mostly) Republicans since the FDR days anyway. It's gotten particularly bad since Newt and his ilk stormed in. Compromise used to be an art form on Capitol Hill. Now it's an obcenity.
posted by Pollomacho at 1:20 PM on March 22, 2010 [1 favorite]


Saul - those are great steps and I'm simply unambiguously glad about them. I had completely missed that 80% number - that's pretty damned good.

I want to close by reiterating that I do consider the bill a good thing (and somewhat better than when I signed on here) - and I really hope it leads to better things.
posted by lupus_yonderboy at 1:21 PM on March 22, 2010


we should bind together more tightly

Who's "we"? There will never be 100% agreement on either the left or the right. In terms of the vote count yesterday, to repeat this a third time, the potential for division among Democrats is coming from the Blue Dog "middle" and not the Deaniacs or whatever.
posted by HP LaserJet P10006 at 1:22 PM on March 22, 2010


On the one hand: yay! On the other hand: I still can't afford health insurance.

Agreed. As for health-care reform, I can't get too excited. As a political victory, I hope this allows the Obama Admin to get some good stuff done during his term.

Racism, Homophobia Dominates (sic) Tea Party Protest Over Health Care Bill

Tea Party Head Spinner: Socialists Oppose Health Bill

My concern, like others, is containing the cost of premiums. If health insurance premiums rise 200% over the next few years, it seems like government-supported health care will be discredited, and further progress will be inhibited. On scanning the news, that apparently seems to a GOP talking point du jour ...
posted by mrgrimm at 1:22 PM on March 22, 2010


"The alternative was nothing, and no health bill of any magnitude for at least ten years."

I fail to understand why everyone seems to think anyone would be proposing "doing nothing".


I think what people are saying is that poltical momentum would be destroyed by a defeat of this bill and we'd have to wait another 17 years, like the last time we went through this. I think what you are arguing is that we could start again the next day with no serious loss to our position. I don't think that is a realistic assessment of how US politics work. That's really my only objection to the positions you guys are putting forward. That you are getting the politics wrong and hurting us on this and future issues.

I'm really focused on the future options. I'm of the opinion we can be more hardassed on the finance bill, because of the politics and optics. People hate the banks right now and it will be an easier fight. But DADT and Guantanamo are going to take time.

I can't give sources, but Guantanamo is hitting big legal snags behind the scenes that are not politics-related.
posted by Ironmouth at 1:23 PM on March 22, 2010


40 minutes ago from Boehner: "I mean no disrespect to the urban community, but it's sad to give handouts to welfare moms & rappers while real Americans lose their jobs."

Where does this guy get his stereotypes? The 1980s?
posted by reenum at 1:24 PM on March 22, 2010


Where does this guy get his stereotypes? The 1980s?

Yes he really should update his stereotypes; there's nothing so uncouth as an out-of-date racist slur.
posted by HP LaserJet P10006 at 1:26 PM on March 22, 2010


rollbizThere's a lot of reasons you could choose to argue against this bill, but your methodology with this one sucks. Pregnancy is not a hereditary disease, for starters...

I disagree. It is highly unlikely that a woman will get pregnant unless her mother did.
posted by ricochet biscuit at 1:28 PM on March 22, 2010 [3 favorites]


The Twitter account is pretty funny, but how long can it last?
posted by mrgrimm at 1:29 PM on March 22, 2010


Me: For the record, @GOPBoehner is a joke account.

shii: For the record, it's my joke account... :)
posted by Pope Guilty at 1:31 PM on March 22, 2010


You know what would go a long way to solving this healthcare debacle? Having an actual Left party. This decade's Democrats are the Republicans of a generation ago. Single payer? That requires a real Left party. Universal coverage? Again, don't be looking at the Dems: you need a proper Left.
posted by five fresh fish at 1:32 PM on March 22, 2010 [1 favorite]


Me: For the record, @GOPBoehner is a joke account.

Who are we going to believe about this?

The 'word' of Pope Guilty and Shii or the Tweets of @GOPBoehner himself?
posted by mazola at 1:34 PM on March 22, 2010 [3 favorites]


My concern, like others, is containing the cost of premiums.

The five most promising cost controls in the health-care bill - written by Ezra Klein, who has proven to be one of the single most informed people throughout this whole process.

The first one addresses how this creates a more competitive insurance market. A quote from that section: If all goes well, consumers will be able to log onto the exchange's Web site, compare insurance plans and choose their favorite. That means insurers will have to compete for customers in a more transparent market, where shoppers have more information, and where the relationship between price and quality is more obvious. As any free-market conservative will tell you, that should drive prices down and quality up. If it doesn't, insurers will have some annoyed legislators to answer to: The bill says congressmen and their staff members need to buy their insurance from these exchanges, too.
posted by DrGirlfriend at 1:35 PM on March 22, 2010 [7 favorites]


The sad thing is that I believed that the tweets on that account were true. It's sad that such views are entirely plausible in today's society.
posted by reenum at 1:36 PM on March 22, 2010 [2 favorites]


It is weird, but oh well. Speaking of Rush's move, anyone who wants to chip in to buy him a plane ticket can donate here.
posted by joedan at 3:15 PM on March 22 [+] [!]


I will not contribute one fucking nickel for a passenger airline ticket for that dipshit.

However, I'm in for ten bucks to put his ass in a cargo sling, chopper him down the coast and drop him on the beach. Tourists can then scoop buckets of water over him until he either revives or else floats back out to sea.
posted by toodleydoodley at 1:37 PM on March 22, 2010 [7 favorites]


One other point. The way to get the Blue dogs to vote for you is to attack the GOP to their right.

I'm not completely sure this will work. Take Dan Boren of Oklahoma, a Democrat serving a district where Obama has a dismal 27% approval rating. How do you attack those to the right of him (and yes, even though he's a conservative Dem, he's still more liberal than the rest of the Oklahoma delegation)? He has to tack right as much as possible lest he lose his seat while remaining a Democrat. Yeah, you can take shots at the Birthers in his district, but most people in Little Dixie are lower class church going whites who have a xenophobic attitude towards them city slickers. You have some liberal talking head cluck disapprovingly about Jim Bob from Atoka and his belief that Obama is setting up concentration campus, and you know what happens? They'll vote for him.

Given that it still looks like the Dems will lose ground this fall in the House, it's paramount that every seat be defended. You can't just cede a Blue Dog's seat to the GOP -- especially not when it's someone like Boren, who with a 51% approval rating and a vote against HCR will easily roll his Birther/Truther GOP opponent come November.

And the thing is that the longer people like Boren can hang on to places like Stilwell and McAlester the more likely that the coming generations will also vote Democrat. The 2nd gave us House Speaker Carl Albert, and it helped elect Boren's father to the Senate as a Democrat and a multitude of Democratic governors.

Sometimes the best thing you can do is be pragmatic. Maybe the compromises suck from a progressive-liberal view of things, but health care reform is now just a couple of Senate votes and the president's signature from being passed. Without the Blue Dogs, nothing would have changed.

As Churchill supposedly said, there are two things no child should see -- the making of sausage and the making of law. For as idealistic as we want the process to be, in the end it is messy and it is pragmatic.
posted by dw at 1:38 PM on March 22, 2010 [1 favorite]


Pregnancy is not a hereditary disease, for starters...

Interesting gestational tidbit: a woman's pregnancy technically begins on the last day of her last period before fertilization.

That generally means that a woman is generally about two weeks pregnant BEFORE the egg is fertilized.

Following that (perverse) logic (of mine), it means that EVERY fertile woman is pregnant between the last day of their period and the first day of their next (and the ones who conceive are pregnant another 36 weeks or so).

No, I wouldn't call it a disease. But I would call it a medical condition that affects a very, very large number of women, regardless of whether or not they ever conceive.

The sickle-cell anemia analogy wasn't that bad.
posted by mrgrimm at 1:38 PM on March 22, 2010


Interesting gestational tidbit: a woman's pregnancy technically begins on the last day of her last period before fertilization.

Technically, it doesn't begin then. For all uses of counting how old the fetus is, that's the popular method of determination. But not technically speaking....
posted by anniecat at 1:43 PM on March 22, 2010


Saul - those are great steps and I'm simply unambiguously glad about them. I had completely missed that 80% number - that's pretty damned good.

I want to close by reiterating that I do consider the bill a good thing (and somewhat better than when I signed on here) - and I really hope it leads to better things.


Thanks Lupus. I appreciate your taking the discussion seriously and being willing to reevaluate your positions in light of new info. I always try to do the same, but of course, it really isn't easy.

People's doubts about this legislation are understandable, especially given the way the media coverage has been so confusing and misleading on so many key points throughout this sausage-making process. But I'm even a little surprised how much good stuff did make the final cut.

I have to admit there was a point where I felt a deep, deep anxiety that this legislation would be so flawed that it would ultimately just set the whole process of reform back, but actually, this didn't turn out so bad. It could be better, sure--I'd like to see single-payer myself. And a lot will depend on implementation. Laws are a lot more like requirements than like functional specs. The specs (administrative rules, etc.) will ultimately play as big a role in determining how these laws hold up to the test of reality.

But this legislation does a lot of good stuff, gets us a lot closer to universal coverage, and really establishes in law that Americans have a right to affordable health care. And all of that is long overdue.
posted by saulgoodman at 1:45 PM on March 22, 2010 [2 favorites]


functionequalsform, there is a strong case to be made that the Massachusetts reform has been pretty successful, albeit incomplete (in the sense that costs are still rising quickly, though that's true nationwide). It's undeniable that it's been very effective at expanding coverage: the state now has only 2.6% of its population uninsured. That's the lowest in the country; other states range from a low of 7.5% uninsured in Hawaii to a high of 25.2% uninsured in Texas.

Of course, health insurance coverage doesn't necessarily translate into health care access, which is what you're asking about. A recent article in Health Affairs (May 2009 if you're interested) analyzed surveys about health care access from before and after health reform passed. The author found that access to care increased after reform passed: between 2006 and 2008, the percent of adults with a regular source of care jumped from 86% to 92%; the percentage with a doctor visit in the past 12 months rose from 80% to 85%; and most importantly, the percentage who reported not receiving needed care because of cost dropped from 17% to 11%.

Even if the short-term effects were to make access to care worse, as a lot of new people flooded the system--which, to be clear, doesn't appear to have been the case in Massachusetts, media coverage nonwithstanding--that doesn't seem to me to be a good argument against reform. If there's a problem with health care access, that either means that we have an insufficient number of physicians or an inefficient way of getting people who really need care in front of a physician who can help them. Failing to pass health care refom doesn't address either of those problems, while the provisions in the bill that passed last night at least try to address some of the potential reasons why access might be a problem (for example, raising reimbursement rates for primary care physicians).
posted by iminurmefi at 1:53 PM on March 22, 2010 [1 favorite]


It appears to have taken four years, from 1957 to 1961, to extend coverage across [Canada].

This is more of an artifact of the two different systems, imo. Canada (like other Westminster-based parliaments), essentially elects a dictator every four years. The only check on a (majority) Prime Minister is consideration of what will happen next election. Party discipline is so rigid as to be a certainty. MPs vote against their party at the peril of their careers. It happens almost never. Legislation, if it's a Government priority, happens in a matter of a few weeks usually.

In the case of health care, the federal government had a lot of negotiating to do with the provinces, mostly over cost sharing. The fed was also, unusually for Canada, in a minority Parliament with the left NDP holding the balance of power. With the clear backing of both parties however, a majority of the votes, there was never any question that the final bill would pass.

Imagine how quickly things would have gone if there were no need to whip votes, no individual deals or assurances to be made. That's how Canada's (and Australia's and NZ's and the UK's) system works.
posted by bonehead at 1:58 PM on March 22, 2010 [1 favorite]


Wow, can't believe I read the whole thing (this thread, not the bill which I only mostly read).

I came here to say I think incremental steps are fine right now. This is the way politics in America works. Tons of wailing and gnashing of teeth, then movement. But Americans are quick to accept the new reality. To use an analogy about legislative outrage from the left, think about the Iraq war. When they gave Bush (may damnation and hellfire be upon His name) the go ahead to invade, it was all about how we were going to try that fucker for treason and get all those bastards out of office and undo this terrible crime. Here we are, 10 years later, war is a fact of life, Bush (MDAHBUHN) was proven to have lied, no one's been found guilty of a crime and most of these assholes are still in power.

Same thing's going to happen with this legislation, 6 months from now people will accept that everyone* who reaps the benefit of health care has to pay and everyone* is entitled to some kind of protection from predatory profit-driven companies. Though it's a small step legislatively in the right direction, it is a monumental philosophical shift and one that I think the non-lunatic fringe majority of this country will readily accept. When we wake up the morning after this bill is signed, and we're not living in a totalitarian socialist state (whatever that means) the Glen Becks and the Tea Baggers will look like the fools they are. And that's a hell of a stepping off point for future reform.

And, as has been linked and described abundantly above, there is a lot of great stuff that this bill does like very soon.



*may not include everyone at this point, but you know what I mean, a lot more people than now.

posted by Slarty Bartfast at 2:01 PM on March 22, 2010 [2 favorites]


I'm not going to wade into the fray here. I'm just stopping by to remind you to let your elected officials know how you feel.

As far as I am concerned, I just wrote to my representative, who voted against this, to tell him he doesn't represent ME personally and I am disappointed that he is contributing to the problem rather than solution, and to my senator, who voted for this, to let him know I appreciate his efforts and assure him we aren't all homophobic, racist, bigoted Tea Party nutcases down here.
posted by misha at 2:02 PM on March 22, 2010 [2 favorites]


I started receiving EOBs today for a series of procedures I recently had done, culminating in back surgery a couple of weeks ago. The first EOB, today, covers the hospital bill for a two-day stay in February. I was admitted for observation in order to 1) Dial-in the appropriate pain meds for the horrifying back pain I was having, and, 2) Do an MRI to get a clearer picture of what the problem was. That was it. Except for the trip down to the MRI, I was in a bed on an IV (including self-dosing morphine) And got oral meds every 8 hours or so.

For those two days, the hospital billed my insurer $18,185. I'm assuming that includes the MRI.

Until we get a serious handle on the expense portion of the problem, we are far, far from affordable healthcare for all. Perhaps, once insurers are restricted from jacking-up their rates capriciously, maybe we'll start to see some real corporate warfare, where the great insurance fleet brings their lobby guns to bear upon the medical/industrial navy?
posted by Thorzdad at 2:04 PM on March 22, 2010


Oh man twitter is down. Crazy.
What I'm saying is that until the GOP stops with its scorched earth strategy, we should bind together more tightly and not -- Ironmouth
Well, you're not really making a very appealing case. Your main argument seems to be "back the president 100% or the republicans will win!", when in fact our goals are not to get whatever the president wants, but rather what we want. Simply rolling over is not a good way to achieve goals.

There's also a game theory aspect to this, which people get intuitively but it's also mathematically true. If you have a situation which is positive sum for both parties, but you feel you could get an even better deal, it makes sense to bail if you think there will be more opportunities for negotiation down the road.

A more specific example. Let say you have a deal for $100k, but you don't think that's fair. Let's also say there's a 10% chance of getting $200k. Obviously you take the deal. But what if there's a 10% chance of getting $1.1 million? Theoretically, you should take it. If you always take statistically advantageous bets, then over the long run, you come out ahead.

There's also a future cost. If people think you're a push over, they'll try to take advantage of you. If they don't, they won't. So it might be in your best interests to go for the $200k if you think it's what's fair because then people will be less likely to take advantage of you in the future. So even though you lost money on this round, you'll change the perception among other people.

It's just like in poker. Sometimes you play hands that are statistically unlikely to win, because if you only play good hands, then people will always fold to you.
posted by delmoi at 2:11 PM on March 22, 2010 [1 favorite]


Until we get a serious handle on the expense portion of the problem, we are far, far from affordable healthcare for all. Perhaps, once insurers are restricted from jacking-up their rates capriciously, maybe we'll start to see some real corporate warfare, where the great insurance fleet brings their lobby guns to bear upon the medical/industrial navy?

There is a vicious cycle going on when it comes to providers' charges. For the most part, if, say, a hospital accepts a particular insurance, it is agreeing to their reimbursement rates. Almost without fail, those rates are going to be under actual costs. So the hospital jacks up the price in order to compensate. This forces the insurance company to raise its reimbursement rate a bit, and in this way they teeter-totter their way to a middle ground. Although sometimes reimbursement goes down even more, then everyone's heads explode. Actually, what happens is that if the insurance reduces their rates enough, it runs the risk of losing the contract with the hospital.

My hope here is that as insurance companies are forced to be more competitive, it's not just their premiums that will need to be adjusted - it's their reimbursement rates, too. I am madly trying to find an article I saw recently that illustrates how medical costs could come down because of how this bill promotes more competition between insurance companies but unfortunately I can't find it.
posted by DrGirlfriend at 2:14 PM on March 22, 2010


Interesting gestational tidbit: a woman's pregnancy technically begins on the last day of her last period before fertilization.

That generally means that a woman is generally about two weeks pregnant BEFORE the egg is fertilized.


What? No. Pregnancy begins when the egg is fertilized, period. Since the exact date of conception is typically difficult to calculate, doctors determine a woman's due date and approximate gestation by the day after their last period ended. The due date and approximate gestation times are rough guesses and certainly aren't set in stone. But conception is the only factor which determines pregnancy.
posted by zarq at 2:16 PM on March 22, 2010 [6 favorites]


sotonohito: "I do think that the Republicans will take care of a several of the Blue Dogs for us. Those vile scum are mostly from Republican leaning states, and I don't think their votes against health care reform will save them from the rising tide of teabagger hatred. No one with a "D" in front of their name will survive in areas where the teabaggers have any influence at all, no matter how many hippies they punch.

So yay, I guess. The Blue Dogs hurt us badly, they made any "victory" here dirty and got in one last fuck you to women everywhere, and now they'll be dragged down by the people they tried to suck up to, there's a certain degree of poetic justice in that.
"

This seems short-sighted to me. Yes, the Blue Dogs are frustrating, and their collusion with Republicans helped water down this bill significantly. But they're still Democrats. Sure, they may stand in the way of some of the most important Democratic measures, but how would replacing them with Republicans -- who would stand in the way of every Democratic measure -- be an improvement? Especially Republicans who, by virtue of defeating an already-conservative Democrat, would be almost guaranteed to be even more conservative?

Take a look at this story from FiveThirtyEight which lists the most and least valuable Democrats in terms of how often they voted for the party line on key issues compared with the political alignment of their district:
The key thing to notice is that some of the most conservative Democrats are actually the most valuable. For example, Chet Edwards of Texas voted against his party on health care, cap-and-trade, the jobs bill, and financial regulation, but with the Democrats on the other six policies. But because he hails from an R+20 district, each of those yea votes (and these were yea votes on important policies, not tokens) qualifies as something of a minor miracle. Indeed, 12 of the 25 most valuable Democrats are Blue Dogs.
On the other hand:
Although 12 of the 25 most valuable Democrats are Blue Dogs, so are 8 of the 21 least valuable ones. It's short-sighted to lump the Blue Dogs together; they disagree on as much as they agree, and although some of them are among the most counterproductive Democrats, others are among the most worthwhile.
In other words, forsaking a Blue Dog is only worth it when they're either not liberal enough for a liberal district (in which case a primary challenge would make sense) or they're waaaaaay too conservative for even a conservative district (in which case even a generic Republican would vote with the Democrats more often).

It should also be noted that when Silver re-ran the numbers recently -- but counted opposition from the left against a congressman's value to the party instead of ignoring it -- the least valuable Democrat was in fact Dennis Kucinich, who is so liberal that it would be better for the party to replace him with somebody slightly less so who would actually be willing to vote for their bills. His support for the health care bill may improve his standing somewhat, but it's still illustrative of the real issue: Democrats who vote against Democratic bills less often than their district's political stance would suggest.
posted by Rhaomi at 2:24 PM on March 22, 2010 [4 favorites]


The problem is that when people like Pope Guilty or Joe Beese just go on about how this bill is the end of America itself it really pisses off a lot of people. This isn't about gloating or anything like that, but rather it's having a lot of people who deeply supported reform getting slapped in the face by people who barely know the facts and just post biased articles with hollow claims.

This bill is going to do a lot of good, but it's not perfect. I don't think anyone here was against the public option, but unfortunately it was unobtainable this cycle. Needing exactly 60 votes in the senate really put a wrench in things and forced us to compromise with the conservative dems who knew they had the power. And don't for one second believe they wouldn't have let this bill die if they didn't get what they wanted.

No this isn't about converting you into centrists either. But for fucking sake at least smile when something good happens instead of talking about how this was really just a secret bill to give the insurance industry more money. I mean none of us have read the bill in totality, but most of us have at least looked at the bulletpoints. So when there is something in it that seeks to lower the rates that insurance companies charge and you make some false argument that this will really just make us all poorer, it's aggravating.

I mean I don't really expect anyone on metafilter to be a troll like most other online communities, but when you are subjected to such ignorance it's hard to keep your cool. This is a bill that does a lot of good and hopefully with the momentum of it we can continue to improve and add to it. I'm not saying you shouldn't complain, but what I am saying is at least do it with the knowledge that life is better with the passage of this bill than without it.
posted by Allan Gordon at 2:32 PM on March 22, 2010 [5 favorites]


You know, I've been thinking (and forgive me if this has been covered before and I haven't seen it); the same people seem to believe both that they will be rich someday and that they will never get sick. It must be wonderful to lead such an optimistic existence.

So why are they so angry all the time?
posted by ilana at 2:32 PM on March 22, 2010 [20 favorites]


Does this bill have any investigatory language? Not long ago I perused a bill I received for a procedure and was more than a little surprised at some of the costs. A couple of friends (nurses) and I discussed the bills for various procedures. We came to the conclusion that hospital pricing of procedures was interesting, to say the least. A number of factors, hardly exhaustive, were discussed: odd departmental splits in bills, incredibly expensive pills, recouping of losses on some patients by charging the heck out of others, one-use pieces of equipment which perhaps did not need to be so (and we're not talking stuff you'd necessarily want in an autoclave), and so forth.

Writing checks and legislating action is grand and all, but it seems that we could help ourselves in discovering what causes, in a detailed and quantified manner, the far-past-inflation rise in our health care costs, and then look for places where we might constrain cost growth in a manner which might not be unduly burdensome to, say, people, as opposed to giant corporations.
posted by adipocere at 2:32 PM on March 22, 2010


adipocere, not sure what you mean by "investigatory language," but the bill does have a whole lot of pilot programs and other experiments to try and contain cost growth.

It's been recommended at least twice in this thread, but the Atul Gawande article Testing, Testing is a must-read for people who want to understand better the delivery-side reforms that are included in the bill.
posted by iminurmefi at 2:37 PM on March 22, 2010


There is a vicious cycle going on when it comes to providers' charges. For the most part, if, say, a hospital accepts a particular insurance, it is agreeing to their reimbursement rates. Almost without fail, those rates are going to be under actual costs. So the hospital jacks up the price in order to compensate.

I remember reading somewhere that someone actually checked their reimbursement on a multi-thousand dollar procedure, and it was only $500 or something. But if he didn't have insurance, he'd have to pay the whole amount. Pretty fucked up situation. People without insurance should be the ones getting the discounts!
posted by delmoi at 2:47 PM on March 22, 2010 [1 favorite]


I'm saying the position was short-sighted and hurt us. And if the GOP is going to continue to resist like this, we need a plan that takes that into account. Nobody is entitled to support. But we're better off if the folly of that position is acknowledged and taken into account for the rest of the Obama Administration.

I'm not sure that the current strategy didn't take it well into consideration. While this year-long blahblah was frustrating to many of us and the Gang of Six process was irritating and seemingly pointless, the result is a bill that has hundreds of amendments proposed by republicans.

So are they going to get some mileage out of this "repeal!" talk? Sure. But I think they're going to have problems where the rubber hits the road. With so many little sops in there for them they're going to have a harder time of identifying things to remove. Expect to start hearing about every republican-proposed idea that made it into the bill.

They're also going to have a challenge using this as a simplistic talking point in elections, I think. There's now a laundry list of things people get out of this bill that can start to be discussed as the heat dies down. Pre-existing conditions, coverage for your kids as they set out to make their way in the world, free preventative care visits... There's a lot of little things in there that the average middle class dudes will be able to identify as being to their benefit.

What's the counter argument going to be? Nebulous claims about the costs of mandates that are years away? Opposition now is going to be harder. Every time someone hears about something that does them a concrete good and then hears the cry for repeal that's going to be a problem for opponents.
posted by phearlez at 2:47 PM on March 22, 2010 [1 favorite]


In the case of health care, the federal government had a lot of negotiating to do with the provinces, mostly over cost sharing. The fed was also, unusually for Canada, in a minority Parliament with the left NDP holding the balance of power. With the clear backing of both parties however, a majority of the votes, there was never any question that the final bill would pass.

I recognize that the Canadian and UK governments are different enough from that of the United States, that it is not possible to categorically say we could do it in four years. But it is possible to do it, and it can be completed in several large, if controversial, moves.

Part of the problem is that, on the surface, the US has a two-party political system that sets up zero-sum confrontations. Another part of the problem is that, underneath that surface, we have a lobbyist infrastructure that politicians of both parties answer to instead of their constituents. Both problems poison the well and actively prevent sensible legislation getting through.

Here, the politicians on both sides of the aisle dragged out deliberations and played the public's strings for the benefit of private insurers. By dragging things out, a series of endless back-room compromises watered down and eliminated President Obama's initial promise of a public option as an alternative, added language that reinforces unconstitutional restrictions on abortion, and provided financial payola to insurance companies for lack of meaningful cost controls.

It is possible to set up single-payer insurance in the United States, which recognizes the same human right to medical care that other industrial countries recognize. But the process would have needed to be swift and its proponents forceful. The 2008 election created a strong Democratic majority Congress and a Democratic president that provided the opportunity to accomplish this goal. This opportunity was missed, badly, and it is unlikely it will ever come again in our lifetimes.
posted by Blazecock Pileon at 2:49 PM on March 22, 2010 [1 favorite]


This article from Slacktivist perfectly captures the tone of last night's Republican speechifying:
If you close this window in your browser, the world will soon end in a fiery cataclysm.

Not "the world might end," but the world will end. And it will do so as a consequence of your closing this window in your browser.

We're talking cause and effect. If ... then. If X, then Y. You close the browser window and thereupon Armageddon, apocalypse, human sacrifice, dogs and cats living together, The End.

I am warning you. Do not close this window of your browser. If you close this window, the United States will cease to be a free country. It will thereupon become a socialist, totalitarian state in which socialist totalitarian thugs will come to euthanize your grandmother -- your very own sweet, gentle grandmother. And then the water of the great river Euphrates will be dried up to prepare the way for the kings of the East and they shall gather together in the valley of Megiddo and the seventh angel will pour out the seventh bowl of wrath and taxes shall increase.
posted by teraflop at 2:51 PM on March 22, 2010 [4 favorites]


But for fucking sake at least smile when something good happens instead of talking about how this was really just a secret bill to give the insurance industry more money.

I'd have preferred single payer but I think folks opposed to the way this is being rolled out are failing to appreciate the way it comes together.

In general, the way this bill is structured everyone has to buy private health insurance if they're above the poverty level. Up to 4x the (insanely low) poverty level, there are government subsidies. The company they buy it from must spend 85% of their total premium intake on care.

In general, how do you find this different from a system where the government spends money it takes in from its graduated tax plans on care for its citizenry?

There's a lot of little ways it's different but sometimes it feels like what most cranks some people up is that this way there's 15% ending up in the pockets of private business. And I have to say to you as a former contractor... that's happening in stuff funded by taxes rather than mandates too.

The other drum we're going to hear beat about this, I am sure, is the paean to the Magical Ability of The Private Sector... but by the democrats this time. That's some kung fu shit right there.
posted by phearlez at 2:57 PM on March 22, 2010 [1 favorite]


The 2008 election created a strong Democratic majority Congress and a Democratic president that provided the opportunity to accomplish this goal. This opportunity was missed, badly, and it is unlikely it will ever come again in our lifetimes.

I'm not sure the opportunity was ever there. Didn't 34 Democrats vote against this bill? A majority of Democrats doesn't mean a majority of people who support single payer. I think Obama did a pretty good job of making the best of an unbelievably difficult situation.
posted by Go Banana at 2:58 PM on March 22, 2010 [2 favorites]



There is a vicious cycle going on when it comes to providers' charges.


Yeah, and the different way that various payors reimburse can lead to some very perverse effects. Since Medicare and Medicaid pay prospectively, based on a fee schedule or case rate, there's no net revenue benefit to raising prices on services that are exclusively consumed by those patients. Lots of times the most powerful managed care payor in a provider's market (most likely a Blue Cross) can negotiate prospective reimbursement as well.

So if a provider needs to squeeze out more net revenue juice from their price structure, the most effective way to do it is to build the rate increase towards services that are mostly consumed by patients with insurance that pays on a percentage-of-charge basis. Do that too much though, and they're handing the market over to that dominant managed care payor, since they'll be making its competitors less and less competitive - sometimes providers have no choice, though, when they're just trying to keep their heads above water.

Personally while I think this bill is a great step, any long-term cost control is going to have to address the crazy-quilt of reimbursement methodologies in use now, and probably move away from fee-for-service entirely towards a system more like the case rates Medicare uses to reimburse inpatient stays.
posted by strangely stunted trees at 3:00 PM on March 22, 2010 [1 favorite]


People without insurance should be the ones getting the discounts!

They can, but they have to ask (nice, I know). If you tell your hospital's billing department that you are uninsured and are paying out of pocket, many should be able to reduce the price for you because what they are charging you is the same as what they are charging the health insurance companies. Which is not fair, given the reason the pricing structure is what it is, so many places will reduce them if you talk to them about it.
posted by DrGirlfriend at 3:00 PM on March 22, 2010 [1 favorite]


So when there is something in it that seeks to lower the rates that insurance companies charge and you make some false argument that this will really just make us all poorer, it's aggravating.

That the bill seeks to lower rates doesn't mean it will actually lower them. Some of us feel that the mechanisms by which rates are supposed to go lower are not realistic because they are based on a dogmatic and too-blind faith in the tenets of neoliberal market economics and that, in fact, such "competition" as you get in an industry in which collusion and price-fixing are legal, in which many players have statewide monopolies or near-monopolies, in which the only real price controls (the medical loss ratios) have no plausible means of being enforced, and in which prices are inelastic within a fairly wide range (because of the individual mandate up to 8% of income) is more likely to raise prices than to lower them. The fact that you make different assumptions and come to different conclusions does not mean that we are being disingenuous in come to ours.

I tend to think there's probably enough of worth in the bill to make it a slight improvement even with the inevitable price-gouging, but I don't think the people who feel that it's worse than nothing are crazy to think so.

And, on preview:

Up to 4x the (insanely low) poverty level, there are government subsidies.

They expire in 2019.
posted by enn at 3:02 PM on March 22, 2010 [1 favorite]


and probably move away from fee-for-service entirely towards a system more like the case rates Medicare uses to reimburse inpatient stays.

Agreed. I actually think fee-for-service's days are numbered. I mean, they are still long days, but there are more efficient ways to do this and fee for service exasperates pretty much everyone.
posted by DrGirlfriend at 3:03 PM on March 22, 2010


I have an honest question for those people who are upset about the anti-abortion language in the bill (I guess I'm looking mostly at you, allen.spaulding and Joe Beese): Not that I disagree with the importance of the symbol or the message this bill sends, but has there been any analysis done on what tangible effect this is likely to have on the ability of (particularly low-income) women to get abortions? My understanding is that the average cost of a first-trimester abortion is somewhere in the range of $500-$1000, which (at least under my insurance) would barely even meet the deductible. So I guess my question is, are women currently using their insurance to get abortions? And if so, how is this likely to change?
posted by albrecht at 3:06 PM on March 22, 2010 [2 favorites]


Love Ezra Klein's take on things. Jonathon Cohn is also an excellent source of info on health care policy on his TNR blog.

Also worth reading for informed commentary on healthcare policy:
Maggie Mahar's Health Beat and Merrill Goozner's Gooznews.
posted by madamjujujive at 3:11 PM on March 22, 2010 [1 favorite]


re: Blue Dogs

They didn't vote for this, but if we vote them out of the party, we're no better than the Republicans voting out "Moderates." And look where that's gotten them so far.

No, do what we can to get candidates we like elected, but if you're a big "D" Democrat, if a state picks a Blue Dog, work your ass off to get them into office.

We're either a big tent party or we're not much better off than the Republicans.

I mean, let's at least learn a lesson from their defeat here.
posted by Joey Michaels at 3:14 PM on March 22, 2010


So why are they so angry all the time?

Because they think that President Obama is spearheading an international communist conspiracy to sap and impurify their precious bodily money.
posted by one more dead town's last parade at 3:14 PM on March 22, 2010 [3 favorites]


(And I do mean bodily money—how else do you think they'll keep their "real" money safe, other than carrying it on them at all times, preferably with a sidearm to defend it?)
posted by one more dead town's last parade at 3:22 PM on March 22, 2010


Some of us feel that the mechanisms by which rates are supposed to go lower are not realistic because they are based on a dogmatic and too-blind faith in the tenets of neoliberal market economics

There are actually two ways that this bill aims to lower cost growth, and only one is through direct competition between insurers in the exchanges. That has an inherently limited scope, because such a small percentage of the population is going to be eligible for the exchanges in any case. Most people receive their health insurance through their employer and will continue to do so for the next decade or so.

The bigger potential pathway for lowering cost growth is in the delivery-side reforms, and specifically in the creation of the Independent Medicare Advisory Commission (IMAC) and the various demonstrations for payment reforms that move the entire system away from fee-for-service. It's worth noting that the move to prospective payment for inpatient hospital stays--which isn't just used by Medicare, but at this point is used by a whole lot of private insurers as well--was originally hatched as a demonstration project, was shown to reduce costs while not hurting care, and its subsequent adoption nationwide by Medicare was quickly followed by private companies adopting the practice (to the extent they were able to, given their size / bargaining position vis-a-vis local hospitals). The basic model of using Medicare as a laboratory to figure out how we can use payment reform to move to a more integrated system rewarding outcomes rather than activity, then rolling it out for private companies to copy, is (at least in my opinion) the core of the reform for lowering costs.

However, that stuff isn't very easy to talk about (let alone understand if you're not somewhat well-versed in the health care market already), and so it's not surprising to me that politicians have focused on the "competition lowers prices!" message instead, which is widely accepted in the U.S. after the massive deregulation spree of the 1970s. I think it's a mistake to conclude from that, though, that the legislation is pinning all its hopes for cost-control on competition within the exchange.
posted by iminurmefi at 3:22 PM on March 22, 2010 [4 favorites]


Whew. Okay. Good stuff here. NOW ... when the dust clears we have work to do.

Can someone offer some fpps for:

- Which HCR supporters are going to face hard fights this November and what can we do to help them?

- Who is organizing a *recharged* push for reproductive care (FREE contraception/vasectomie/tubal ligation) and a complete overhaul of the educational focus (ending support of ALL abstinence programs; giving FULL funding to free clinics and medical advisers who will help teens learn the truth; providing better sex education programs in the schools and on television; distributing free condoms EVERYWHERE)

- Where do we send our money/support for a NATIONAL bank for free/low cost abortions?

- When and how do we start pushing for the public option law?

Thank you for any help you can offer. We have only just begun our fight.
posted by Surfurrus at 3:24 PM on March 22, 2010 [3 favorites]


enn, do you have a link to anything about the subsidies expiring in 2019? I've been following the various pieces of legislation fairly closely (as closely as one can without actually having the law degree necessary to read the bill itself), and I've never heard anything about that.
posted by iminurmefi at 3:31 PM on March 22, 2010


five fresh fish: You know what would go a long way to solving this healthcare debacle? Having an actual Left party. This decade's Democrats are the Republicans of a generation ago. Single payer? That requires a real Left party. Universal coverage? Again, don't be looking at the Dems: you need a proper Left.

There isn't a Left party because there aren't enought Left voters. I know the Netroots think that somehow there would be a Democratic Socialist Utopia in America if it weren't for the DLC, but this isn't Europe or Canada. I'm not sure why you think the Democratic Party should be pushing for policies significantly to the left of what they, their voters, or the country wants. Despite what they may say, The DailyKos/FireDogLake/Metafilter vote is not one that wins many elections.
posted by spaltavian at 3:34 PM on March 22, 2010 [1 favorite]


Anyone want to shed a tear for poor Mitt Romney? Obama and Pelosi passed a health care bill that's (at least partially) modeled on his system in Mass and he's reduced to railing about legislative process hoping none of the tea-baggers have long memories.
posted by octothorpe at 3:37 PM on March 22, 2010


I'm not sure why you think the Democratic Party should be pushing for policies significantly to the left of what they, their voters, or the country wants.

I think the Democratic Party should position themselves as the new Republican Party, and that an entirely new party should form on the left.

The Republican Party should, of course, just go die in a hole somewhere. They shifted themselves so far beyond the reasonable Right that they are now utterly useless cretins.
posted by five fresh fish at 3:41 PM on March 22, 2010


Interesting gestational tidbit: a woman's pregnancy technically begins on the last day of her last period before fertilization.

That generally means that a woman is generally about two weeks pregnant BEFORE the egg is fertilized.


Never before has a commenter's total lack of uterus been so readily apparent.
posted by elizardbits at 3:50 PM on March 22, 2010 [18 favorites]


I've been trying to explain to family members how this law will impact them. But the more I read, the worse it looks. My mother asked me whether or not this law would effect Pennsylvania's plan for single-payer, a plan that has bipartisan support here and a governor who has pledged to sign, and that would save everyone money while providing health care for all. At first I ignorantly told her that this law would have no effect (because surely health care reform wouldn't include anything that would hurt single-payer). But of course I had to check on it, and I find that states cannot get a waiver to implement their own better plans until 2017. In the meantime they have to go through all the trouble and expense of setting up the exchanges and enforcing the new law against the people.

Is there anything in the reconciliation bill that would fix this? I looked over it but I didn't see anything.

I'm scared to even tell my family about all of this, because we all had our hopes up over the PA plan. I did warn them that nothing good comes out of this system of things, and the PA plan was too good to be true. But I wasn't expecting it to be blocked this way. This whole healthcare thing is making me sick with worry. But things are supposed to get a lot worse before they get better, and this seems like part of it. Teaches me to get involved in any way with politics.
posted by Danila at 3:57 PM on March 22, 2010 [1 favorite]


he's reduced to railing about legislative process hoping none of the tea-baggers have long memories.

I'd say that's a good bet.
posted by EarBucket at 4:03 PM on March 22, 2010


mccarty.tim: Personally, I've always thought of Rush Limbaugh as an angry little gnome who lived in old domestic cars' radios. Considering that he's stuck inside of a Taurus with broken AC, I understand why he's so cranky.

Of course!! Rush is the "neighbor boy with evil on his mind" in Helen Reddy's 1974 song Angie Baby! (lyrics - wiki) The dates check out and everything.
posted by msalt at 4:25 PM on March 22, 2010 [2 favorites]


wish i had read the last night instead of following all that inane twitter stuff...what was i thinking!?!!?
posted by lslelel at 4:29 PM on March 22, 2010 [1 favorite]


[Mitt Romney] hoping none of the tea-baggers have long memories.

He's got nothing to worry about, they can't remember the first sentence in a paragraph by the time they come to the end of it. There isn't a one of them who has the slightest idea that Romney's in any way connected to a health care plan.
posted by Jimmy Havok at 4:33 PM on March 22, 2010


When I heard about this last night, I wept. Stupid big soggy weeping. With relief and joy, with a little disappointment, with hope for our future and with the fear of hope. I wept with the intensity of one who felt momentous CHANGE.

I HAVE coverage; I'm on Medicare in the US and likely to be so until I die or it's gutted. I'm not one of the people who need this bill. (Although extra $ to Arizona for Medicaid will be MIGHTY handy; we don't have services many other states provide.)

But watching the congressional process I've been feeling like Mom(D) and Dad(R) have been fighting in the kitchen in front of everyone - with Dad obviously drunk and sounding like he was going to get violent - over health care reform. The House passing this bill was, for me, like Mom finally stood up for herself and knocked Dad out with the skillet. It feels like things will actually be different after this.

Oh, yes, Obama... I'll stop referring to you as "Sissybritches" now. I voted for you and you broke my heart when you gave up public option. I am actually a little stunned now.
posted by _paegan_ at 4:37 PM on March 22, 2010 [4 favorites]


The basic model of using Medicare as a laboratory to figure out how we can use payment reform to move to a more integrated system rewarding outcomes rather than activity, then rolling it out for private companies to copy, is (at least in my opinion) the core of the reform for lowering costs.

There are some interesting pilots taking place outside of just the scope of Medicare too: for instance, there are three integrated-system providers that are piloting, along with the Brookings Institute and Dartmouth, the Accountable Care Organization model; sort of a hybrid fee-for-service system with more bundling and global holdbacks from the FFS payments that get turned into incentive payments for utilization management and outcomes of care. There's a Medicare piece too, and in fact the new bill includes funding for more Medicare pilots, but the initial pilot facilities have also already been negotiating directly with their commercial payors to set this up.
posted by strangely stunted trees at 4:37 PM on March 22, 2010


so, my original snark was, why is Rush Limbaugh planning to move to Costa Rica, a spanish-speaking country with socialized health care? but if the majority population is white criollos, I guess he only has to adjust to the socialist part, and somebody can translate for him. I still think it's weird.

Didn't a lot of Libertarian/Survivalist types from the US move to Costa Rica to be out of the reach of the federal government?
posted by acb at 4:43 PM on March 22, 2010


Mom(D) and Dad(R)

Wait, does that mean you're an Independent?
posted by HP LaserJet P10006 at 5:10 PM on March 22, 2010


This is from the CNN story about the lawsuit some states are planning to file against the HCR bill:

All of the attorneys general in the 10 states mentioned by McCollum [Fla. AG] are Republican, but McCollum said the lawsuit would be about the law and not politics.

I try not to generalize, but it's like if a Republican opens their mouth, you can be assured a lie will come out. There use to be one or two Republican politicians I respected even if I didn't agree with them, for the life of me I can't think of one I'd even let come in my house right now.
posted by marxchivist at 5:14 PM on March 22, 2010 [1 favorite]


People are offended by a reference to the Challenger Space Shuttle? That's hilarious.
posted by Gamien Boffenburg at 5:46 PM on March 22, 2010


Hey Splunge:

Who FORCED him to remove the public option? Who essentially blackmailed him? The fucking right. Right?

Wrong. Last time I checked, Obama and the Democrats have majorities in both parts of Congress. The ones that made him dump the public option were the Democrats who didn't want to tell their constituents to go fuck themselves. And, before the upset in Massachusetts, the Democrats had a super-majority in Senate. So, just to set the record straight here (or to inflame you liberals who don't understand shit about how American government works), Obama's had nearly *AN ENTIRE FUCKING YEAR* to get this done, and just barely made it on Sunday.

I mean, they've shown to be even more inept than the Republifucks, and I was certain that couldn't happen.

So, don't blame this shit on the right. They had pretty much no part of this. Blame it on the fractiousness, duplicity and underhandedness of your own fucking people.
posted by CountSpatula at 6:10 PM on March 22, 2010


I think the Democratic Party should position themselves as the new Republican Party, and that an entirely new party should form on the left.

The Republican Party should, of course, just go die in a hole somewhere. They shifted themselves so far beyond the reasonable Right that they are now utterly useless cretins.


The Tea Party is to the Republican Party what this Left Party potentially would then be to the Democratic Party. Look, I hate me this two party system, too, but unless we're able to scrap the single-member district plurality system of holding elections and replace it with something like a proportional representation system, the unpleasant, pragmatic reality is this appalling "either or" proposition.

So, let's first work to change the way we hold elections and then we can start talking about a serious Left Party. Until then, the best bet those of us on either extreme of the political equation have is to be willing to work with and compromise with as large a group of people to the middle as possible.

Once we have our proportional representation system in place, we can leave it to our reps to do the compromising on our behalf. Or, in the case of the Tea Baggers, the becoming irrelevant and pissy.

"I repeat myself when under stress." Adrian Belew
posted by Joey Michaels at 6:20 PM on March 22, 2010


I should know better than to respond to someone who actually uses the term "Republifucks" unironically[1], but...

Obama's had nearly *AN ENTIRE FUCKING YEAR* to get this done,

Yeah. He's had absolutely nothing else on his plate during that time. He's just been, you know. Kicking back. Shooting some hoops with his bros.



[1] - Note: I could not have more contempt for the current Republican party, but at the same time, I see absolutely no reason to resort to cutesy, Limbaugh-esque gutter snipes.
posted by sparkletone at 6:27 PM on March 22, 2010 [5 favorites]


For those wanting some sober (and yet truly even further hope bringing) context to this incredibly historic movement/moment...
I highly recommend tracking down an interlibrary loan, or a used copy, either way, I highly recommend reading "Accidental Logics" by Carolyn Hughes Tuohy.
It provides a deeply researched look at the "accidental logic" that brought each of Britain, Canada, and the USA their care and treatment services as they are.

It is a few years old now... but very detailed and just amazing in it's scope. It covers everything you don't know but should about all three of the nations and the evolutions from the original "logic" that brought about public medicine in each country; essentially, our health care will from now on have "genes" from this shift in public policy.

There are some very important lessons from the two countries besides the USA whose health care reforms were studied.

The important thing to look at is the "institutional mix"- there are three traditional actors. The State, The Doctors Colleges, and Private Enterprise.- balancing these interests is something that must occur.

One thing that potentially needs to be watched, and is already much more so an "American thing" is the proliferation of "entrepreneurial medicine" (exotic procedures that are just technologization of things that people can/should do and cost less done by a person.)
Any word on how access to Midwifery fares under these changes?

For my personal opinion, having looked at the other two systems a lot more than a little... I really think we have something going here with this system overhaul beginning now; one important lesson I think I have seen is that how accommodations are made in the upcoming period will most certainly affect how the effects of the changing system are felt by all people, (though I would add, and I think everyone else realizes this already, with these changes we are going for "pools" of a "Few million" to get insurance, for the bulk discount... just imagine the group rate discount you start to get when you vote for the insurance of a block of 333 million.)

The founder effect is strong with these shifts though!
Thank you for representing the needs of Americans, o' ye people of the Congress.
Now it's time to get back in there and really make sure these changes don't take away anybody's rights or ability to get services that they used to have access to!

Danila, some hope might lie in the idea that with the Federal Government as a single payer to each States for all the transfer payments needed to "make change/provide care", it is far, far easier to institute some form of single payer system. It is not impossible for this to start a "single payer" slippery slope. (I have hope.) The logic of this system is well grounded!
Canada works, and it does so even with a system that seems confusing, but really started out with just a "concept"... essentially; "we've gotta look out for people facing their most trying times"- and people who aren't deathly worried about just making it to tomorrow have much more time/capital/mental energy, to pursue dreams, and entrepreneurial endeavors.
MONOPSONY (one buyer) powers used only in “very gross terms”.
Decisions about the allocation of resources made through negotiations with the MONOPOLY providers of services (Most essentially, the Medical Profession)
Negotiations which left “great discretion” in the hands of the organized medical profession (Doctors Colleges) to govern its members behavior.

ininurmefi; Independent Medicare Advisory Commission (IMAC) sounds a lot like the cost saving, and streamlining programs from other systems, Britain created the DRG systen (Diagnosis Related Groups), which related resource use to clinical diagnosis.
And the USA adapted this idea to found the PROSPECTIVE PAYMENT SYSTEM of HOSPITAL REIMBURSEMENT for Medicare in the US.
Canada played ‘me too’ and the HMRI (Hospital Medical Records Institution) developed the CASE MIX GROUP system(CMG)- these were not used to adjust how much, or where government payments went; rather they were used internally by individual hospitals to evaluate how best to allocate resources from their global budgets.
posted by infinite intimation at 6:31 PM on March 22, 2010 [2 favorites]


The Tea Party is to the Republican Party what this Left Party potentially would then be to the Democratic Party.

Riiiight.

Do you understand that your Democratic Party would be considered a right-of-center in most other countries?

If so, you should understand that a real Left Party in the US would be slightly left-of-center. Which is not anything at all like the "so far right they fell off the edge of the map" Tea Party.
posted by five fresh fish at 6:39 PM on March 22, 2010 [3 favorites]


Does anyone know how I can get a link of Rachel Maddow explaining what this new Healthcare Bill means for us, right now? And 30 days from now? And 90 days from now, etc... I just hit pause on Tivo because I'm dying to share it with everyone on the planet, but ironically just had to have a major medical thing dealt with today so I'm a tad high from lots of intense and outrageously expensive drugs and my Google skillz aren't what they should be. The show is airing right now, the 22nd.

And BTW I'm so not even going to engage with people who are enraged by this bill in any way. It just makes me too mad and too sad. I own a small business. I have employees. I desperately want to buy health insurance for all of us. But I also have a really expensive disease (MS) and that has meant that I have ZERO chance to buy any kind of health insurance. Even if I were somehow able to afford 100k per month they still wouldn't insure us. How on earth is that capitalism? Or entrepreneurial? Or American???

So frankly, fuck all this negativity. This right here is what I have been fighting for--and I've been fighting and worn out by this bullshit for way too long. Reading some of the comments upthread kinda makes me want to cry (again, I am kind of high right now) when really all we should be doing is drowning in champagne and confetti.

Anyway, the Maddow link... Really seriously please? I'd like to post that on Facebook if someone knows how to find it. Thx.
posted by ohyouknow at 6:46 PM on March 22, 2010


Wait, does that mean you're an Independent?

You'd think, if I'm still under Mom(D) and Dad(R) authority, I'm just a Dependent.
(And, since I'm on Disability and Medicare, you'd be right.)
posted by _paegan_ at 6:52 PM on March 22, 2010 [1 favorite]


iminurmefi: I searched the Kaiser Foundation's side-by-side HCR bill comparison PDF for 2019, and found this, though I'm frankly not sure whether it implies that subsidies will go up or down:

Increase the premium contributions for those receiving subsidies annually to reflect the excess of the premium growth over the rate of income growth for 2014-2018. Beginning in 2019, further adjust the premium contributions to reflect the excess of premium growth over CPI if aggregate premiums and cost sharing subsidies exceed .54% of GDP.

(Top of page 6 of the PDF).

The following has been linked upthread, but it's worth repeating. In addition to having the PDF available, the KFF lets you create a customized, detailed summary of the differences among the original House Bill (the more progressive one with the Public Option), the Senate Bill (the less progressive one that the House passed on Sunday), and the Budgetary Reconciliation Bill (which the House also passed on Sunday to override parts of the Senate bill).

They also have an interactive Health Reform Subsidy Calculator! "This tool illustrates premiums and government assistance under the types of reform proposals being considered for people under age 65 who purchase coverage on their own in an Exchange and are not covered through their employer, Medicare or Medicaid."
posted by sentient at 6:53 PM on March 22, 2010


I hope we can get this expanded and fix the ridiculous holes in our system that are preventing you, and so many like you from getting coverage-- This is not a Right way to operate a civil society; and to think that people are willing to aggressively oppose reform. With misinformation and simple base reactions to buzz words and lingo.

I will look for a maddow link... this?
posted by infinite intimation at 6:57 PM on March 22, 2010


The ones that made him dump the public option were the Democrats who didn't want to tell their constituents to go fuck themselves.

Well, they can. Quite vigorously, actually.

Screw those guys.
posted by dunkadunc at 7:02 PM on March 22, 2010


ohyouknow -- Yeah, the Maddow clip will probably be here in the next few hours.
posted by sentient at 7:03 PM on March 22, 2010


Thanks infinite intimation for the virtual hug--much appreciated. I don't think that's the link though. I tried poking around in MSNBC a little more. Perhaps because it just aired it won't be on their site? Maybe I should check YouTube?
posted by ohyouknow at 7:04 PM on March 22, 2010


As a 48-year-old small business owner of 22 years who has not had any health insurance for the last 8-9 years may I just chime in and say

Brah-VO.

I'm trying to live the American Dream here and as far as I'm concerned it just got better.
posted by Ron Thanagar at 7:08 PM on March 22, 2010 [1 favorite]


Here here! (Or is it Hear! Hear!??)
what a strange expression...

TERRORIST FIST BUMPS FOR ALL!!!
posted by ohyouknow at 7:15 PM on March 22, 2010 [3 favorites]


Thanks sentient, I'll refresh that in a few.
posted by ohyouknow at 7:17 PM on March 22, 2010


Here's another good resource: NYT has an article answering "Readers’ Questions on the Health Care Overhaul." It's pretty informative, and has some good links, I think.

(Also: no problem, ohyouknow.)
posted by sentient at 7:19 PM on March 22, 2010


Having passed that hurdle, someone with balls should proposed amending the bill to include a public option. Everyone got whipped into majority line and passed what was the real tough part: admitting that the old way of doing healthcare doesn't work, and trying something new.

Just like you don't stop the baby when it takes its first step, don't stop healthcare's first step.
posted by five fresh fish at 7:46 PM on March 22, 2010 [2 favorites]


Riiiight.

Do you understand that your Democratic Party would be considered a right-of-center in most other countries?


I understand this and posit that if you take half of the Democrats and put them in the Left Party and run both parties against the Republicans and the Tea Party, you're going to see a lot more Tea Party pandering Republicans in elected offices.

Its numbers, money and ability to walk in lock step with each other even against their own best interests.

All I'm sayin' here is that if you want to make a Left Party a viable political reality, we need to reform the way we do elections, because otherwise everyone to the left of Far Right is going to be hard pressed to win elections.

Until then, we serve our own long term best interests here by surfing game theory with the Centrists.
posted by Joey Michaels at 7:55 PM on March 22, 2010


Having found confetti and champagne at DailyKos, I will now switch from blue to orange...
posted by ohyouknow at 7:59 PM on March 22, 2010


Britain created the DRG systen (Diagnosis Related Groups), which related resource use to clinical diagnosis. And the USA adapted this idea to found the PROSPECTIVE PAYMENT SYSTEM of HOSPITAL REIMBURSEMENT for Medicare in the US.

DRGs were originally developed and rolled out in America, not Britain. They were invented by Fetter and Thompson, who were public health professors at Yale, with funding from HCFA.
posted by strangely stunted trees at 8:00 PM on March 22, 2010


A few days before the vote, Nate Silver at fivethirtyeight.com did an interesting model-based analysis of whether progressive Democrats could have been successful in pushing for the public option: Progressives' Strategic Choices on Health Care Likely Made Little Difference.
... perhaps the most important finding of the model is that the outcome was relatively robust. Although there are a number of things that Democrats could have done a bit better, essentially all of the scenarios that I tested produced a score between a 50 -- a bill something like Senate Finance Committee's -- and a 60 -- a weak public option. It would probably not have been possible to get a strong public option (much less anything resembling single payer) even if a number of variables were changed within reasonable boundaries.
posted by russilwvong at 8:17 PM on March 22, 2010


Well, okay, Joey, having a real Left Party is one of the many things that need to be done.
posted by five fresh fish at 8:17 PM on March 22, 2010


That's completely wrong. The subsides are forever.

Yeah, on reread you had it right, I guess. I'm not sure where I got the claim I made there... still, the rest of it holds true.
posted by zvs at 8:23 PM on March 22, 2010 [1 favorite]


The 200 add-ons tacked on by the Repubs...what are they?
posted by Jumpin Jack Flash at 8:45 PM on March 22, 2010


Wow, yeah, nice catch strangely stunted trees... It seems I am unable to read my own handwriting sometimes almost always... an error malfunction the cause of which lies entirely with human unit me, the book was not the cause of my carelessness.

The DRG definitely being as you say, fully American; and the British using the HRG system, Healthcare Resource Group to establish casemix - thank you for noticing this mistake... sorry for making it.
posted by infinite intimation at 8:47 PM on March 22, 2010


five fresh fish: seriously, we get it. Go fix Canada.
posted by lalex at 8:55 PM on March 22, 2010


Whatever our opinions on the bill, surely we can all gather together to enjoy a nice glass of freeper tears.
posted by Pope Guilty at 8:57 PM on March 22, 2010 [1 favorite]


Is that something I would need a t.v. health care to understand?
posted by infinite intimation at 9:01 PM on March 22, 2010


Drink their tears.

On preview, not a dupe of PG's link.
posted by five fresh fish at 9:22 PM on March 22, 2010


It's amazing, looking back over this thread, how many people had no idea just how good this bill actually was (myself included). Damn.

Who benefits most from no one realizing all this time that the bill's actually got a lot of good stuff in it? The Republicans because that makes the bill sound worse than it is? Or the Democrats, because it keeps the Republican base from getting too wound up about it? Heh.

I can't really tell who did their job better: the Republicans or the Democrats. Well, wait. Yes I can. The Democrats won. The Republicans wanted to stop this, and they didn't.

And I think the Democrats may have actually done a much better job of this than I was expecting/assuming, now that all the details are starting to come into focus.
posted by saulgoodman at 9:33 PM on March 22, 2010 [2 favorites]


Have we had more comments than the hipsters on food stamps thread yet? Because, you know, this topic must deserve at least as many comments as that one does.
posted by saulgoodman at 9:40 PM on March 22, 2010


Nope. That one's 883. This one's only 716, so far.

Keep 'em coming ladies and gentlemen.
posted by saulgoodman at 9:41 PM on March 22, 2010


MetaFilter hates hipsters more than Republicans.
posted by grouse at 9:58 PM on March 22, 2010


Coming back from Kos, this is my favorite link.

And this is my favorite quote: "Obama's great strength is patience. He has, as no one I can think of has had in recent times, an ability to just completely ignore the 24 hour news cycle. Whether it was his pre-Iowa nomination lull, or his summer 2008 doldrums, or his methodical planning for Afghanistan, or, over and over again, his refusal to panic on health care, the pattern is about as clear as any could be.

....Yes, I do think it's an enormous strength. he apparently just doesn't care at all about winning the news cycle, or the day, or even the week. He wants to win elections, and passage of legislation, and, I suspect, the war in Afghanistan. He seems, as far as I can tell, to surround himself with people who have the same view.

I'll say one thing: I wouldn't bet against him."


May I just add to all the Nancy Pelosi naysayers... Suck it! And I of course mean that with a lot of hopey lovey changey happiness.
posted by ohyouknow at 10:00 PM on March 22, 2010 [4 favorites]


Ok, here's something interesting... I noticed this in the reconciliation bill, regarding the mandate that everyone be covered: "Exemptions will be granted for financial hardship, religious objections, American Indians, those without coverage for less than three months, undocumented immigrants, incarcerated individuals, those for whom the lowest cost plan option exceeds 8% of an individual’s income, and those with incomes below the tax filing threshold." (emphasis added).

Heh... apparently if you don't want health insurance, and don't want to pay the fine, all you have to do is prove that you're a Christian Scientist.

So, I imagine you won't be allowed into a clinic or ER if you're exempt from insurage coverage for religious reasons? /partial sarcasm
posted by sentient at 10:16 PM on March 22, 2010


I will gladly partake in the tear drinking.

Sweet, sweet bitter tears.
posted by Joey Michaels at 10:23 PM on March 22, 2010 [1 favorite]


"I'd dearly love to see some real socialism in this country if only so conservatives can stop complaining about the center-right party we call the Democrats."
posted by DU at 6:58 AM on March 22


Actually, one of my 2012 campaign slogans is "Think that's socialism? I'll show you socialism." -- or something to that effect, still not quite sure how to phrase it.

(yeah, I've got a joke campaign running, and by running I mean "running gag with my friends")

Also, I call my party the LSD Party (Libertarian Socialist Democrats): Red, Black Green are the party's colors - Red for Socialism, Black for Liberty, Green for Environment.
posted by symbioid at 11:22 PM on March 22, 2010


saulgoodman: Or, rather, it wants more and better Medicare benefits than it wants to benefit those fucking kids who might possibly be also sucking off the Federal teat.

You, asshole kids on my lawn, get off this thing! You can reattach when you're 65, but not a moment before! *slap*

I'm personally really super-happy about the parents' healthcare thing, as that means a lot for my brother, who is a grad student now. It would have changed my life, that's for sure.
posted by electronslave at 12:02 AM on March 23, 2010


Blazecock Pileon: The 2008 election created a strong Democratic majority Congress and a Democratic president that provided the opportunity to accomplish this goal. This opportunity was missed, badly, and it is unlikely it will ever come again in our lifetimes.

While I too wish single payer had been truly in play, I disagree 100% that the Dems will not have these majorities again in our life time.

Look at the demographics trending. The GOP is losing young people, has lost the Hispanic vote, the black vote, the gay vote, and is basically comprised of older whites and is trending towards the extremes represented by the Tea Baggers and those within the party itself. I truly believe the GOP is on a moribund trajectory. I don't think any organization that is so obsessed with nostalgia at the cost of reality and the present is well on it's way to become obsolete. Any real violence and they will lose the independents and many moderate COnservatives who simply could not stomach it.

But who knows what will happen if the Citizens United case is allowed to stand.

Anyhow this is a fantastic achievement and I hope the momentum basically just brings the demise of the useless GOP even sooner.
posted by Skygazer at 2:44 AM on March 23, 2010


Aw, shit. Twitter suspended GOPBroehner, just as he was getting funny. Why do they hate free speech so much?
posted by mccarty.tim at 5:01 AM on March 23, 2010


I propose we smith a cocktail that has the same consistency and taste of a neocon's tears. It needs to be salty, bitter, and have a hint of closeted fruitiness.
posted by mccarty.tim at 5:04 AM on March 23, 2010 [6 favorites]


I am somewhat ambivalent about the health care reform bill. I'm happy for the people it's going to help, and I do hope it will lead to better reformations of our health care system, but it looks like my household makes a little over a thousand dollars too much to get any help getting health insurance, and currently only one of us is insured. We would both be insured, if we could afford it, so here's hoping the cost of insurance drops, or I'll be paying the tax penalty and continuing to be uninsured.
posted by Orb at 5:44 AM on March 23, 2010


MetaFilter hates hipsters more than Republicans.

What's the difference?
posted by Pollomacho at 6:02 AM on March 23, 2010


It needs to be salty, bitter, and have a hint of closeted fruitiness.

Salty Dogs all around!
posted by Pollomacho at 6:07 AM on March 23, 2010 [1 favorite]


Looks like you can add Indiana to the list of state's attorney generals who are going to challenge the constitutionality of this bill. Oh, and out governor (who just happens to have designs on running for President) is out beating the drums of doom and disaster. He's putting a hold on the state's low-income insurance assistance plan, claiming that this HCR bill has destroyed it.
posted by Thorzdad at 6:36 AM on March 23, 2010


It's amazing, looking back over this thread, how many people had no idea just how good this bill actually was (myself included).

The Democrats' messaging has been absolutely incompetent throughout this whole affair. All we should've heard from any Democrat over the last year+ is "Medicare for everybody. Medicare. For. Everybody." Instead the polls have people opposing the bill even though they support the elements of the bill.

For those calling this a huge victory for Obama, that is yet to be seen.

It's definitely a huge victory for Obama. Getting this through despite unanimous Republican opposition, incompetent Democratic messaging, public ignorance, and media bias is a major political victory. The bill isn't everything it could be, or should be. It may prove to be a Pyrrhic victory come November, although I don't think so. But this is a major W.

Well, which Civil Rights Act do you mean? Because legislatively, the Civil Rights Act of 1875 covered everything.

You don't have to go back that far. The landmark Civil Right Act of 1964 was preceded by and built on incremental acts in 1957 and 1960.
posted by kirkaracha at 6:42 AM on March 23, 2010


Again, the issue is that none of these interesting but minor cuts address the elephant in the room - that at least one health dollar in three goes to insurance companies, people who neither directly provide you health care nor support or organize those who do.
Lupus_wonderland

It's just like in poker. Sometimes you play hands that are statistically unlikely to win, because if you only play good hands, then people will always fold to you.
...Sorry, couldn't find who said this upon preview


Here's the thing, though --

-- If you're playing poker and you lose, no one dies.

And --

-- if we did nothing now but attempted to correct the insurance company overcharges, it would take time to attain that goal, and in the meantime, people would die.

I'm reminded of something a friend of mine told me once; he was in training to become a Jesuit priest. However, he wasn't ever given any "preach-the-gospel" kind of work to do -- he strictly did outreach work to the homeless, hungry, and ill. And -- he was never asked to do any preaching while he was at work in soup kitchens and the like.

His superior explained to him that this was because of his personal philosophy about "spreading the Good Word" -- "look, people aren't going to be ready to HEAR about the Gospel if they are strung-out, hungry, cold, or homeless. So our job isn't to convert them. Our job is to feed, clothe, and shelter them, and tend to their illnesses. Then if God wants to take 'em the rest of the way, GOD can do that. Our job is just to level the playing field first."

Ideally, yes, you're both right -- tending to the health insurance industry or strengthening our own political clout are consumations devoutly to be wished. But the problem was, there were other, bigger flaws in the system that were letting people die right now. This bill is taking care of them -- and is making sure that much fewer people die while we are tackling those other, more complicated problems.

And personally, I'm okay with "stopping people from dying" being the first priority before we go on to tackle other issues.
posted by EmpressCallipygos at 6:56 AM on March 23, 2010 [10 favorites]


Again, the issue is that none of these interesting but minor cuts address the elephant in the room - that at least one health dollar in three goes to insurance companies, people who neither directly provide you health care nor support or organize those who do.

They pool risk for a fee, dude. Its insurance. They hold a big pile of money that millions give to them so that if something goes wrong, the health bills are taken care of. I'm not saying its the greatest system ever, its only risk pooling for profit. Even single-payer is the same thing, but with tax dollars.
posted by Ironmouth at 7:18 AM on March 23, 2010


Again, the issue is that none of these interesting but minor cuts address the elephant in the room - that at least one health dollar in three goes to insurance companies, people who neither directly provide you health care nor support or organize those who do.

Well, this isn't true in any way, shape or form--only 7 percent of all health care spending is administrative, and a big chunk of that is actually government administrative costs. (About half of all health care dollars are spent by the government, primarily through Medicare, Medicaid, and the VA; private insurance only spends about one-third of all health care dollars.)

Whatever the virtues are of moving to single-payer are, realizing huge savings by eliminating insurance carrier administrative costs ain't one of them. At most you're talking about a one-time cost savings of *maybe* five percent of total medical spending (under the most optimistic assumptions), and since health care costs are rising at 7 to 10 percent per year, you're back in the exact same place within 12 months. Eliminating insurance companies isn't the key to solving our cost problem, because insurance companies aren't the cause of the cost problem. It's the underlying medical costs.
posted by iminurmefi at 7:32 AM on March 23, 2010 [1 favorite]


at least one health dollar in three goes to insurance companies

They pool risk for a fee, dude. Its insurance.

It is true that they pool risk, the problem is what they do with the pooled money. When they invest it in obvious investment bubbles and credit default swaption leaving the consumer with no coverage and higher premiums in order to cover dividends, then we have problems.
posted by Pollomacho at 7:44 AM on March 23, 2010 [1 favorite]


Well, this isn't true in any way, shape or form--only 7 percent of all health care spending is administrative, and a big chunk of that is actually government administrative costs.

Actually, I think this figure is depends upon how "administration" is defined. This study published by the New England Journal of Medicine found that, after exclusions, administration accounted for 31.0 percent of health care expenditures in the United States (and 16.7% in Canada. The study also found that between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. Granted this study was published in 2003 based on 1999 data and it would be interesting to see current figures.
posted by Staggering Jack at 7:59 AM on March 23, 2010


That New England Journal of Medicine article takes a broader view of administrative overhead than just billing and insurance compliance. For instance, for hospitals, they're defining administration as the following cost centers: "administrative and general, nursing administration, central services and supply (excluding the purchase cost of supplies), medical records and library, utilization review, and the salary costs of the employee benefits department". The insurance-related part of that would be however much of administrative and general is patient access, charge entry, the billing office, manged care contracting, some reimbursement functions in finance, and then some of medical records, utilization review (though the last two also have important patient care functions). And of course a piece of employee benefits if they don't self-insure.
posted by strangely stunted trees at 8:11 AM on March 23, 2010


I read all the comments so far. Been a tiring day, Reading this thread is a great way to wind down. That is all.
posted by the cydonian at 8:14 AM on March 23, 2010


"Many U.S. states are worried that the healthcare overhaul plan approved by the U.S. House of Representatives will usurp their sovereignty and impose more spending on their already stretched budgets.

Republican attorneys general in at least 12 states announced on Monday that lawsuits will be filed to stop the federal government from overstepping its constitutional powers."


How States States Are Responding to Healthcare Reform Law
posted by madamjujujive at 8:14 AM on March 23, 2010


Now live, the signing of the bill.
posted by Ironmouth at 8:18 AM on March 23, 2010


The room greeted Obama and Biden with chants of "Fired up! Ready to go!"
posted by EarBucket at 8:31 AM on March 23, 2010


>: His superior explained to him that this was because of his personal philosophy about "spreading the Good Word" -- "look, people aren't going to be ready to HEAR about the Gospel if they are strung-out, hungry, cold, or homeless. So our job isn't to convert them. Our job is to feed, clothe, and shelter them, and tend to their illnesses. Then if God wants to take 'em the rest of the way, GOD can do that. Our job is just to level the playing field first."

If only Mormons and Jehovah's Witnesses could get that one through their heads.
posted by dunkadunc at 8:34 AM on March 23, 2010 [4 favorites]


Today we are ALL
☭ Амєяікаиs ☭ !


whoops. Did I say that out loud?
posted by mazola at 8:42 AM on March 23, 2010 [5 favorites]


Looks like quite a crowd at the GOP counter-press conference.
posted by EarBucket at 8:48 AM on March 23, 2010 [1 favorite]


Signed, sealed, and delivered.
posted by EarBucket at 8:56 AM on March 23, 2010


So mote it be.
posted by Pollomacho at 8:57 AM on March 23, 2010


Can someone explain all the pens?

Plus: Yay!
posted by waitangi at 8:59 AM on March 23, 2010


Apparently I haven't watched very many live bill signings. What the hell is Obama doing with a different pen for each checkmark or whatever he's doing? I assume this is SOP, but what's the deal?
posted by shakespeherian at 9:00 AM on March 23, 2010


The pens are given out as souvenirs for people who were instrumental in getting the legislation passed--Pelosi, Reid, Dingell, etc. I imagine Vicki Kennedy will get one too. It's pretty common for presidents to do it when signing significant legislation.
posted by EarBucket at 9:01 AM on March 23, 2010


They give the pens to important people that were involved with the bill as a sort of historical token.
posted by Pollomacho at 9:01 AM on March 23, 2010


Usually, what will happen is he'll use a different pen for each letter of his name.
posted by EarBucket at 9:01 AM on March 23, 2010 [2 favorites]


Thanks. It's always cheering to find out I'm the only one who doesn't know something.
posted by shakespeherian at 9:03 AM on March 23, 2010


Can someone explain all the pens government waste?

Just kidding, I think this is awesome. I am in favor of helping people not die.
posted by marxchivist at 9:10 AM on March 23, 2010


Joe Biden needs to work on his indoor-near-the-live-mic voice: "This is a big fucking deal". Well, it beats joking about the imminent bombing of the Soviet Union, but expect complaints to the FCC nonetheless.
posted by maudlin at 9:11 AM on March 23, 2010


Thanks for clearing that up, and thanks to EarBucket for answering my second question.

Now I want a Presidential Pen.
posted by waitangi at 9:11 AM on March 23, 2010


How States States Are Responding to Healthcare Reform Law

I am not a constitutional scholar by any means, but one rich irony here seems to be that the courts (the scotus, at least) will have to back the expansive interpretation of the commerce clause in regard to the constitutionality of HCR, because the conservatives on the court(s) have always ruled that way in the past?
posted by mrgrimm at 9:13 AM on March 23, 2010


Can't wait for Liz Cheney to denounce Biden's language as disrespectful to his office.

He's right, though. This is a huge fucking deal.
posted by EarBucket at 9:14 AM on March 23, 2010


Heh. Michael Steele: “There is no downside for Republicans. Only for Americans.”
posted by EarBucket at 9:19 AM on March 23, 2010 [2 favorites]


Can't wait for Liz Cheney to denounce Biden's language as disrespectful to his office.

You mean like when Snarling Dick told the rankig Democrat on the Judiciary Committee to "go fuck himself" on the floor of the Senate within full earshot of numerous witnesses for asking him about no-bid Halliburton contracts?
posted by Pollomacho at 9:24 AM on March 23, 2010 [1 favorite]


Yeah, pretty much like that.
posted by EarBucket at 9:26 AM on March 23, 2010


Let's just clear something up:
These nitwits waving "IMPEACH OBAMA" signs- What crimes, exactly do they want to impeach Obama for? Because I'm really drawing a blank.

Personally, I think they hate Obama for all the wrong reasons.
posted by dunkadunc at 9:27 AM on March 23, 2010


What crimes, exactly do they want to impeach Obama for?

Won't someone think about their freedoms?
posted by Pollomacho at 9:28 AM on March 23, 2010


Compare 'n' contrast photos: bill signing vs. Republican news conference.
posted by kirkaracha at 9:29 AM on March 23, 2010


What crimes, exactly do they want to impeach Obama for?

The same reason the teabaggers I went to high school with keep insisting on Facebook that the bill is unconstitutional: They've confused "losing" with "tyranny," "majority rule" with "ramming it through," and "I don't like it" with "unconstitutional."
posted by EarBucket at 9:31 AM on March 23, 2010 [23 favorites]


the expansive interpretation of the commerce clause...because the conservatives on the court(s) have always ruled that way in the past?

The Court, specifically Justice Scalia, has had (in my opinion) a very politically-driven relationship with the Commerce Clause in the past 15 years.

In United States v. Lopez (1995), the Court limited Congress' power under the Commerce Clause for the first time since the Great Depression. What a coincidence that the law at issue there was one involving gun control!

Then, the Court placed further limits on Congress' Commerce Clause power in Seminole Tribe v. Florida (1996) and United States v. Morrison (2000).

But then a case came along that made the Court choose between an expansive interpretation of the Commerce Clause and the dread marijuana plant: Gonzales v. Raich (2005). Scalia twisted himself into a pretzel to justify voting with the majority in favor of an expansive Commerce Clause here while maintaining the Lopez line of cases were still correct. To his credit, Justice Thomas dissented due to the same logic that put him with the majority in Lopez.
posted by sallybrown at 9:33 AM on March 23, 2010 [2 favorites]


I'd like to know the name of the fuckhead who called Stupak a "baby killer."

I don't think anyone has mentioned his name yet. it was Randy Neugebauer. Surprise, surprise. He also cosponsored a "birther" bill.

...

How the People in My District Got Stupak to Change His Mind-and Thus Saved the Health Care Bill, by Michael Moore

...

Bart Stupak is no health care hero
posted by mrgrimm at 9:38 AM on March 23, 2010


One preview: dammit! I took too long to write this up but I don't want to erase it now. Following comment is in response to Staggering Jack, who cites a study that comes up really often in these health care threads.

I have some reservations about the methodology of the Woolhandler study (the one in the NEJM), particularly when those numbers are used to argue that administrative costs are the main problem we face. Too often it seems like people are misinterpreting how "administrative" costs are defined in that article, by arguing that they would somehow magically disappear if private insurance didn't exist.

The bulk of those "administrative" costs are the estimated cost to hospitals and physicians for dealing with anything that isn't direct patient care--NOT just the additional cost of dealing with multiple payers. For instance, Woolhandler and her colleagues assign one-third of the cost of office rents for physicians to "administrative costs." In a sense, that might be fair; if one-third of the staff of a physician practice is clerical (note this isn't just billing, but all clerical) then I suppose it follows that part of the rent is covering the additional space needed for those bodies. However they don't account for the basic fact that office rental rates, and all other components of administrative costs, might be higher in the U.S. and that this difference doesn't really represent an excess cost of private insurance--that is, if we moved to single payer and physician practices could all move to offices that were a bit smaller, we still couldn't reach the same level of "efficiency" as Canada because the underlying resource costs aren't the same. Henry Aaron, a very respected Brookings health care economist, makes this point in the same NEJM issue. Woolhandler's estimate of the $209 billion that could potentially be saved in administrative costs by moving to single-payer is actually more like $159 billion if the correct method for calculating excess administrative costs is used. And even that estimate is high, as it doesn't take into account the difference in physician salaries between Canada and the United States, so the true amount we'd save is very likely less, although it's hard to say by how much.

So, in 1999 total health care expenditures in the United States (excluding the 20.6% of health care they didn't investigate, e.g. retail prescription drugs) were a little over a trillion dollars. Taking the excess administrative costs of $159 billion--which are, again, an overestimate, although it's unclear by how much--you're talking about at a one-time potential savings of at most 15% of health spending, if you just hand-wave away all the implementation costs of moving from where we are now to a single-payer system. (All of, say, Medicare's reimbursement rates already take into account the cost of all this administrative work when paying physicians and hospitals, so in order to even capture this one-time savings you'd have to have this new single-payer entity renegotiate all the contracts for every procedure and office visit, which I can imagine very easily eating up all the administrative savings in that first year. If it were even possible, which I think it wouldn't be, because hospitals and the AMA wouldn't react kindly to an across-the-board 15 percent pay cut.) Since there's no reason to think that moving to single-payer will bend the cost curve--and Medicare, our one big single-payer program makes a pretty persuasive case that it wouldn't--all of that work to totally re-arrange the financing of care will buy you an extra two, maybe three, years before you're back where you were before due to high medical cost inflation.

That's why most health care economists don't believe that administrative costs are "the elephant in the room"--yes, maybe you could extract a one-time savings of somewhere between 4 percent (looking strictly at the cost of insurance company overhead) to, at the upper end, 15 percent (including the costs of excess administrative costs on the part of providers to deal with multiple payers). But unless you're solving the fact that medical costs are rising much, much faster than inflation, reducing administrative costs doesn't do much other than buy you a few years before we're back at the very same place. It's not a long-term solution.
posted by iminurmefi at 9:39 AM on March 23, 2010 [3 favorites]


Oh, and I think Neugebauer claims he was calling the bill a "baby killer" and that the comment was not directed at Stupak.
posted by mrgrimm at 9:40 AM on March 23, 2010


And when I shout "useless piece of shit" at Negebauer I am in fact referring to the car he is driving in.
posted by PenDevil at 9:50 AM on March 23, 2010 [13 favorites]


I am not a constitutional scholar by any means, but one rich irony here seems to be that the courts (the scotus, at least) will have to back the expansive interpretation of the commerce clause in regard to the constitutionality of HCR, because the conservatives on the court(s) have always ruled that way in the past?

It's been awhile since I took Con Law, but I think the opposite is true--the right wing of the court has been busily restricting the reach of the commerce clause for years.
posted by Mavri at 9:51 AM on March 23, 2010 [1 favorite]


Robert Gibbs on Twitter just now: "And yes Mr. Vice President, you're right..."
posted by EarBucket at 9:52 AM on March 23, 2010 [3 favorites]


These nitwits waving "IMPEACH OBAMA" signs...

Aren't as bad as the nitwits twittering about assassinating President Obama.
posted by marxchivist at 10:04 AM on March 23, 2010


Heh. Nice one, Gibbs.

Still, I'm a little disappointed that he didn't, in fact, turn out to be the "Whoops! Obama's Talking to the Entire Country" Guy.
posted by Atom Eyes at 10:20 AM on March 23, 2010 [2 favorites]


Yeah, but wasn't everyone with red blood and a soul wishing George Bush would fall down every flight of stairs in the Washington Monument,, have his arm bitten off by a crocodile, or be dragged behind his presidential motorcade for 26 blocks?

Oh wait. That would have actually been funny, he would have deserved it, the people wishing it would happen weren't brandishing guns at town-hall meetings, and an unfortunate crocodile mishap isn't the same thing as getting shot.
posted by dunkadunc at 10:20 AM on March 23, 2010


The most intelligent commentary you will ever hear on the health care bill.
posted by Sticherbeast at 10:23 AM on March 23, 2010 [4 favorites]


SticherBeast: Why you do this?

Oh, and Biden dropped the f-bomb. "This is a big fucking deal."
posted by mccarty.tim at 11:08 AM on March 23, 2010


Ooops, that was upthread. Sorry everyone :(
posted by mccarty.tim at 11:09 AM on March 23, 2010


Yeah, but wasn't everyone with red blood and a soul wishing George Bush would fall down every flight of stairs in the Washington Monument,, have his arm bitten off by a crocodile, or be dragged behind his presidential motorcade for 26 blocks?

I didn't feel this way because I felt like it would be picking on someone who is cognitively challenged. Cheney, though, Rummy and Rove....yeah, that would be just about right.
posted by anniecat at 11:32 AM on March 23, 2010 [1 favorite]


Everybody loves a winner: Americans by 9 percentage points have a favorable view of the health care overhaul that President Obama signed into law Tuesday, a USA TODAY/Gallup Poll finds, a notable turnaround from surveys before the vote that showed a plurality against it.
posted by EarBucket at 11:33 AM on March 23, 2010 [1 favorite]


Oh, and Biden dropped the f-bomb. "This is a big fucking deal."

I must say, I get a huge kick out watching Biden's glowing fatherly pride, while Obama speaks. There's definitely seriously good chemistry there.
posted by Skygazer at 11:39 AM on March 23, 2010 [2 favorites]


Yeah, but wasn't everyone with red blood and a soul wishing George Bush would fall down every flight of stairs in the Washington Monument,, have his arm bitten off by a crocodile, or be dragged behind his presidential motorcade for 26 blocks?

My response to this is usually along the lines of "Barack Obama hasn't killed a hundred thousand people."
posted by Pope Guilty at 11:52 AM on March 23, 2010 [3 favorites]


Tea-baggers Vandalize Democratic Offices Nationwide
posted by HP LaserJet P10006 at 12:03 PM on March 23, 2010


It must be a thrilling time for the extremists who believe this justifies violence. What a bunch of assholes.
posted by lyam at 12:09 PM on March 23, 2010


Stay classy, Tea-baggers.
posted by saulgoodman at 12:10 PM on March 23, 2010


Wow, breaking windows? A "Window War"? What a bunch of pussies.
posted by Saxon Kane at 12:52 PM on March 23, 2010


Why you gotta insult perfectly good lady parts like that :(
posted by internet fraud detective squad, station number 9 at 12:57 PM on March 23, 2010 [9 favorites]


You know who else liked coordinated window breaking...
posted by Artw at 12:58 PM on March 23, 2010 [4 favorites]


Aphex Twin?
posted by shakespeherian at 1:00 PM on March 23, 2010 [4 favorites]


Sorry ifds,sn9. You're right. Pussies are beautiful, friendly, and make the world a better place. I should have called them cowardly shits.
posted by Saxon Kane at 1:04 PM on March 23, 2010 [3 favorites]


(them being the Tea Bagger window breakers)
posted by Saxon Kane at 1:04 PM on March 23, 2010


Why you gotta insult perfectly good lady parts like that :(

I've never seen a lady with a cat attached to her. That said, I prefer the term poltroon.
posted by Pollomacho at 1:06 PM on March 23, 2010


I must say, I get a huge kick out watching Biden's glowing fatherly pride, while Obama speaks. There's definitely seriously good chemistry there.

Like Barney Fife and Andy Taylor=)?
posted by anniecat at 1:08 PM on March 23, 2010


Tea Party Time-Out: 7 Ways to Calm the Conservative Temper Tantrum.
posted by anniecat at 1:10 PM on March 23, 2010 [1 favorite]


The more I see of Biden the more I like him. I seriously think he's the advanced pitch man for the administration. Got a new idea you want to poll but don't want to take the backlash? Just throw Joe out there to drop it as a "gaffe." If the gaffe gets people talking you run with it. If they start gathering pitch forks and torches you just blame "Good 'Ole Joe's Foot-In_Mouth Disease." Silly Joe, how could you say such a thing?
posted by Pollomacho at 1:14 PM on March 23, 2010 [1 favorite]


I love Joe Biden. I love his big palooka heart and his great shit-eating grin. And most of his "gaffes" aren't really gaffes, they're the rare example of a politician letting the truth slip.

You know who else liked coordinated window breaking...

That's right, the Nazis.
posted by kirkaracha at 1:47 PM on March 23, 2010 [2 favorites]


the right wing of the court has been busily restricting the reach of the commerce clause for years

Thanks for the correction. I have no idea, so I'll take your word for it.

That makes me wonder why hasn't medical marijuana made any progress. I thought that the commerce clause was the whole reason the feds were able to keep it illegal federally when it is legal in a state. But again, I'm likely wrong.
posted by mrgrimm at 1:53 PM on March 23, 2010


Aphex Twin is windowlicking.
posted by Artw at 1:54 PM on March 23, 2010 [1 favorite]


I seriously think he's the advanced pitch man for the administration.

Another Obama tactic shamelessly lifted from Bush/Cheney. ^_^
posted by mrgrimm at 1:58 PM on March 23, 2010


Aphex Twin is windowlicking.

Also HOLY GOD THAT FACE
posted by Pope Guilty at 2:04 PM on March 23, 2010


The face! The face!
posted by Artw at 2:15 PM on March 23, 2010 [1 favorite]


That makes me wonder why hasn't medical marijuana made any progress. I thought that the commerce clause was the whole reason the feds were able to keep it illegal federally when it is legal in a state.

I talked about this in my comment above.
posted by sallybrown at 2:18 PM on March 23, 2010 [1 favorite]


Does the commerce clause itself actually mean anything? It seems like some kind of weird legal stretchy taffy.
posted by Artw at 2:27 PM on March 23, 2010


Hi guys! Mind if I just kind of snuggle myself up in here? Warm myself with a bit of wholesome Metafilter kvetching and commenting? Because I just spent the last half-hour or so wandering around the group of blogs that link to the call for "Window Whacking" or whatever it is and damn if it isn't a cold, cold place. I'm chilled to the bone, and feeling a bit ill. Take, for example, the site called the New Clarion, where in the comments you can find this lovely comment, one implicitly approved of by the blog owner when he answered it:
Billy Beck in a recent post said something to the effect that if your child will die because of a lack of socialized medicine that he didn’t care if the kid died at his parents feet. This is harsh but I am beginning to think that it is necessary. I think we need to confront altruists with an undiluted egoism so if they say what of the poor under capitalism our answer should be that if they don’t work and can’t get alms from family or private charity then they very well may die in the street. In essence our answer should be “too damn bad”.
The answer was on the lines of "[Tell those who bring up the 'dying children' argument] If you are so concerned with the needy then get going — don’t waste your time talking to me. Chop Chop!". These people remind me of a particularly good Suck.com parody of Lo these many years past about a young neocon: that what he wanted was deregulation and lower taxes and the usual talking points, but that what he really needed was a year on the land with four hungry children and crop failure.
posted by jokeefe at 3:13 PM on March 23, 2010 [2 favorites]


I think we need to confront altruists with an undiluted egoism so if they say what of the poor under capitalism our answer should be that if they don’t work and can’t get alms from family or private charity then they very well may die in the street. In essence our answer should be “too damn bad”.

I think I would take this argument more seriously if it was a really long monologue in a court scene
posted by Sticherbeast at 3:34 PM on March 23, 2010


This remake of Twelve Angry Men is going to be awesome!
posted by Artw at 3:37 PM on March 23, 2010 [1 favorite]


Coburn is leading the way on ridiculous tactics to derail the reconciliation bill, proposing no-brainer amendments that Senate Democrats will nevertheless have to vote against if they want to avoid sending the package to the House for yet another vote. For instance:
No Erectile Dysfunction Drugs To Sex Offenders – This amendment would enact recommendations from the Government Accountability Office to stop fraudulent payments for prescription drugs prescribed by dead providers or, to dead patients. This amendment also prohibits coverage of Viagra and other ED medications to convicted child molesters, rapists, and sex offenders, and prohibits coverage of abortion drugs.
(I think it would be the height of Stupid Irony if they proposed the kind of rape amendment they all voted against a few months ago, albeit for much less defensible reasons.)
posted by Rhaomi at 3:40 PM on March 23, 2010 [2 favorites]


jokeefe quotes a New Clarion commenter: if your child will die because of a lack of socialized medicine that he didn’t care if the kid died at his parents feet.

I'm reminded of Hobbes' description of a state of nature as a "war of all against all."
posted by russilwvong at 3:40 PM on March 23, 2010


Allow me to introduce my Modest proposal for preventing the children of sick people in America from being a burden to their parents or country, and for making them beneficial to the public...
posted by Artw at 3:47 PM on March 23, 2010 [3 favorites]


Coburn is leading the way on ridiculous tactics to derail the reconciliation bill, proposing no-brainer amendments that Senate Democrats will nevertheless have to vote against if they want to avoid sending the package to the House for yet another vote.

This makes me so mad I can hardly see straight. I won't question his sincerity in not supporting the bill and being disappointed that it passed. But he is one of fifty Senators; he has the power to make concrete changes to better the lives of hundreds of millions of people. He's pissing in the national sandbox because he didn't get what he wanted. Wake up, you privileged fuck, and take advantage of the immense and awesome power that you have to do something that will actually help your country and your constituents.
posted by sallybrown at 4:12 PM on March 23, 2010


I think we need to confront altruists with an undiluted egoism so if they say what of the poor under capitalism our answer should be that if they don’t work and can’t get alms from family or private charity then they very well may die in the street. In essence our answer should be “too damn bad”.

A fair number of Americans hate Americans, don't they?
posted by five fresh fish at 4:38 PM on March 23, 2010 [3 favorites]


2. Bureaucrat Cap and Trade (Amendment 3557) – This amendment would ensure that no provisions in the health bill increase the size of government bureaucracies in Washington, D.C. This amendment requires that for each government bureaucrat added to a government agency as a result of this act, there must be a corresponding decrease in a government bureaucrat at that agency. The federal government should not grow the bureaucracy in Washington, DC when one in 10 Americans is looking for work and twice as many are underemployed.

I love that one. "So many people are looking for work, we can't create jobs now!"
posted by kafziel at 4:46 PM on March 23, 2010 [4 favorites]


The Republican Party is simply built of Fail these days. Geesh.
posted by five fresh fish at 4:59 PM on March 23, 2010


We all know that government jobs are fake jobs*

*see stimulus debate
posted by Think_Long at 4:59 PM on March 23, 2010 [1 favorite]


Oh, and about those 13 Republican AGs who are suing because HCR is allegedly unconstitutional? White House, experts: Health care suit will fail. In my own neck of the woods, our Republican AG, who has gubernatorial ambitions, has signed on to the suit, in what I believe to be a remarkably foolish move politically, and not only is our politically savvy Democratic governor is raking him over the coals for it, but his relevant records are now the subject of a legal disclosure demand and the Democratic controlled legislature is looking at chopping his budget to move forward with the suit.
posted by bearwife at 5:09 PM on March 23, 2010 [2 favorites]


I love that one. "So many people are looking for work, we can't create jobs now!"

Yeah, I don't get that one, either.

During the HCR debate Sunday, one of the Republican women gave her two minute rant and said, "This bill will hurt jobs." followed immediately by "They are going to hire 18,000 new IRS agents...."

I guess government jobs don't count. Does that mean we don't have to keep paying the stupid ones?
posted by Benny Andajetz at 5:30 PM on March 23, 2010 [1 favorite]


Does that mean we don't have to keep paying the stupid ones?

Well yeah, it would be cruel to fire them because they would lose their health coverage.
posted by Think_Long at 5:46 PM on March 23, 2010


By tomorrow evening there should be as many or more comments than the hipsters on food stamps thread.
posted by anniecat at 6:08 PM on March 23, 2010


bearwife, what really kills me is that I voted for that guy. I so very rarely vote for a Republican anything, but he actually seemed like the better choice at the time. Teach me, I guess.

I am loving watching Gregoire rip into him. Whether I agree with him or not on this issue - which I obviously don't - he went about this is pretty much the completely wrong way to not get his ass handed to him by our Democratic governor and state legislature.
posted by Lulu's Pink Converse at 6:39 PM on March 23, 2010


Stock market hit a 17-month high today.
posted by five fresh fish at 7:05 PM on March 23, 2010 [2 favorites]


James Howard Kunstler weighs in with The Party of Cruelty
posted by telstar at 7:56 PM on March 23, 2010 [1 favorite]


I eagerly await the principled announcement from all Republican members of Congress that they, in good conscience, cannot accept Government run health insurance and are thus canceling their gold-plated plans.
posted by jokeefe at 8:16 PM on March 23, 2010 [6 favorites]


I appreciate the larger point, but the "best health care on the planet" meme is just wrong.

Members of Congress get the following health care benefits:

(1) The same personal or family health insurance as any other federal employee.
(2) For additional money, but not the full cost of running it, there's also a clinic at work that can refer to local federal hospitals if needs be. This is not available to family.

That's it. When people refer to "the best health care available anywhere OMG," what they're usually referring to is the standard federal health care benefits. Which are good.
posted by ROU_Xenophobe at 8:49 PM on March 23, 2010


They first killed the public option and the now the right wing is whining about how unconstitutional it is to require corporate health insurance or pay a fine.
posted by Brian B. at 9:42 PM on March 23, 2010


Trololo weighs in. Subtitled, YT.
posted by five fresh fish at 10:43 PM on March 23, 2010 [2 favorites]


The Republican Party is lost in the wilderness.
posted by five fresh fish at 10:44 PM on March 23, 2010


Trololo weighs in. Subtitled, YT.

Bear in mind that I mean this in the best and most positive way: I beleive we have found our new Hitler.
posted by Artw at 11:35 PM on March 23, 2010 [3 favorites]


I notice that you deliferately misspelled "beleive". This is some kind of code, isn't it?
posted by philip-random at 12:21 AM on March 24, 2010


five fresh fish: "Trololo weighs in. Subtitled, YT."

OH MY GOD.

IT ALL MAKES SENSE NOW.

(EVEN THE SPACE PART.)
posted by Rhaomi at 1:20 AM on March 24, 2010 [4 favorites]


Well, this is just great.

Right now, if you go to the actual web site of the actual Republican Party, before you get to the main page, you are first greeted with this.

Look, I try hard to not write off an entire group as jerks. But this? This makes it really, really hard not to do so.

This is a sincere question to Republicans in here -- okay, seriously? The acting House Speaker engulfed in flame? Is that kind of childish behavior really how you want your party to come across? Please tell me you also think this is childish?
posted by EmpressCallipygos at 2:30 AM on March 24, 2010 [6 favorites]


five fresh fish: "The Republican Party is lost in the wilderness."

I don't think that they're lost at all. They're boldly and resolutely marching straight into the wilderness with banners held high.
posted by octothorpe at 5:56 AM on March 24, 2010 [5 favorites]


Well, we weighed her and she was the same as a duck, so...
posted by symbioid at 6:39 AM on March 24, 2010


Pelosi, I mean. (forgot to refer to Empress' comment -- note to self: don't reply so early in the morning)
posted by symbioid at 6:40 AM on March 24, 2010


Is that kind of childish behavior really how you want your party to come across?

There is an intellectual divide between parties that is pretty noticeable in the average red state. From here it seems they are doing it right, expertly appealing to their target audience.
posted by Brian B. at 6:53 AM on March 24, 2010 [1 favorite]


Right now, if you go to the actual web site of the actual Republican Party, before you get to the main page, you are first greeted with this.

Jesus. I'm amazed it didn't try to sell me Ron Paul gold and fake viagra.

What do you think the lead time is on a thing like that?
posted by Artw at 7:16 AM on March 24, 2010 [1 favorite]


This is a sincere question to Republicans in here -- okay, seriously? The acting House Speaker engulfed in flame? Is that kind of childish behavior really how you want your party to come across? Please tell me you also think this is childish?
posted by EmpressCallipygos


It's a dogwhistle to the faithful who literally believe that voting for healthcare reform is sinful. Pelosi's eventual punishment (in their minds) will be to burn in hellfire for eternity. Until that time, they believe, Pelosi must be punished here, on Earth, by the righteous conservatives. The idea in displaying their not-too-subtle image so prominently is to remind Republicans voters who's the boss, to force compliance and get those pocketbooks open.

Interestingly, Scientologists do something similar in Dianetics ads - the book cover and commercials prominently show an exploding volcano, which does not, repeat, not actually symbolize change or growth or even destruction, but instead is supposed to trigger a subliminal "engram" of aliens imprisoned in volcanoes and then, via eruption, disincorporated into spirits, or thetans.

I love that they're both using the same technique.
posted by Optimus Chyme at 7:55 AM on March 24, 2010


Thanks for the armchair explanations, all, but I want to hear from Republican MeFites themselves, as to what they think of their own party pulling this kind of thing.
posted by EmpressCallipygos at 8:17 AM on March 24, 2010


Umm - are there any Republican mefites? I mean, we had Paris and I guess Konolia/St. Alia are the only 2 I can think of. Maybe one or two others, but Paris is long gone (banned?), and Konolia occasionally pops up in some threads, but I haven't seen her here.

I think there's another 1 or 2 but I can't remember their names off the top of my head. Steven C Den Beste? Otherwise, yeah, not many around these parts far as I can tell.

But if you are out there, PLEASE speak up, I, too would like to hear your thoughts!
posted by symbioid at 8:26 AM on March 24, 2010


Thanks for the armchair explanations, all, but I want to hear from Republican MeFites themselves, as to what they think of their own party pulling this kind of thing.

That always goes so well!
posted by hermitosis at 8:32 AM on March 24, 2010


How about this? They repeal it if the Republicans in Congress give up their fat cat health insurance too. No? Why not? Oh right. Wouldn't want to be uninsured....
posted by anniecat at 8:33 AM on March 24, 2010


Umm - are there any Republican mefites?

There are lots of conservative mefites, but from what I remember very few of them publicly identify with the Republican party. Fair enough: I'm a liberal who considers myself independent, even though I virtually always vote for Dems.
posted by Lentrohamsanin at 8:44 AM on March 24, 2010


Maybe EmpressCallipygos should just ask when the MeFite Republicans stopped beating their wives and screwing twinks at rest areas? Seriously, do you expect any of the few conservative leaning folks here to answer such a trollish question?
posted by Pollomacho at 8:51 AM on March 24, 2010


when the MeFite Republicans stopped beating their wives and screwing twinks at rest areas

As if they ever stop before being caught by the media.
posted by five fresh fish at 8:57 AM on March 24, 2010


Pollo, I honestly didn't intend it to be trollish.

I've always avoided joining in any of the "all Republicans are thus-and-such" talk, precisely because I knew that all Republicans were not anything like the more extreme fringe members of the party (the ones usually being pilloried in such "all Republicans are thus-and-such" conversations).

However, to my mind, there is a difference between an individual person who happens to be a GOP member doing something nuts, and the party leaders themselves doing something nuts.

Hell, when people challenge religious folk on here because "the leaders of your church are doing thus-and-such, what do you think of that?" people came in here and affirmed that "oh, believe me, I don't like it very much either." And I am now hoping to see the very same thing happen, so I can continue to believe that such behavior is the action of an individual as opposed to something the whole of the party agrees with.
posted by EmpressCallipygos at 8:58 AM on March 24, 2010


A poster on Gawker found this:

State Attorney General Ken Cuccinelli (R-Va.) knows how to talk the talk, but does he walk it, too? Cuccinelli filed a lawsuit against the federal health care bill in U.S. District Court as soon as it was signed into law. But while he's been busy talking about how awful it is for the government to take care of its uninsured citizens, it turns out he's been using the government to take care of the health of him, his wife and their seven children -- and he's been doing it for years.

Before becoming attorney general, "The Cooch" served for almost eight years as a State Senator. Legislators are not usually eligible for state health insurance, but there is a provision for them to buy into state health care at the cost of full-time or virtually full-time (32 hours +) state employees, according to NotLarrySabato. "So when given the "public option" to insure his family through the state health insurance program, The Cooch chose to do so instead of insuring his family through his law firm. Why would he do this? The General Assembly program allows members to enroll their families for $105 per month -- or $1,260 per year. According to the Kaiser Family Foundation, these benefits would cost about $13,375 for a family policy on the open market. In other words, The Cooch saved about $100,000 over his eight years in the Virginia Senate by enrolling in the voluntary state health insurance program -- which he wouldn't even be eligible for with his work hours if the General Assembly hadn't carved out an exception for itself!
Forget the "welfare queens" of the 1990's. Now we've got the "health care queens" -- led by none other than Attorney General Ken Cuccinelli."

posted by anniecat at 8:59 AM on March 24, 2010 [15 favorites]


Pollo, I honestly didn't intend it to be trollish.

I see your point but asking:

Is that kind of childish behavior really how you want your party to come across? Please tell me you also think this is childish?

is not the same as asking: "I'd like to know if any conservative MeFites find this website [link] over the top or inappropriate or if you approve of the message presented there?
posted by Pollomacho at 9:05 AM on March 24, 2010


Before becoming attorney general, "The Cooch" served for almost eight years as a State Senator. Legislators are not usually eligible for state health insurance, but there is a provision for them to buy into state health care at the cost of full-time or virtually full-time (32 hours +) state employees

Just to elaborate on exactly why being a senator wouldn't get you health insurance since non-Virginians may not be aware: the Virginia legislature spends very little time in session. Delegates are often local practicing lawyers or are in other fields where they can afford to go off to Norfolk for the 60 days they are in session.
posted by phearlez at 9:53 AM on March 24, 2010


The more I see of Biden the more I like him. I seriously think he's the advanced pitch man for the administration. Got a new idea you want to poll but don't want to take the backlash? Just throw Joe out there to drop it as a "gaffe." If the gaffe gets people talking you run with it. If they start gathering pitch forks and torches you just blame "Good 'Ole Joe's Foot-In_Mouth Disease." Silly Joe, how could you say such a thing?

Not exactly the first time this strategy has been used: See under Spiro T. Agnew.
posted by Ironmouth at 10:02 AM on March 24, 2010


where they can afford to go off to Norfolk for the 60 days they are in session.

Not Richmond?
posted by anniecat at 10:08 AM on March 24, 2010


A fair point, Pollo. I stand corrected.

But the question still stands; I'm sincerely curious to hear from MeFite Republicans about how they feel about the GOP site.
posted by EmpressCallipygos at 10:13 AM on March 24, 2010


you just blame "Good 'Ole Joe's Foot-In_Mouth Disease." Silly Joe, how could you say such a thing?

Not exactly the first time this strategy has been used: See under Spiro T. Agnew.


Nattering nabidens of negativity.
posted by grubi at 10:29 AM on March 24, 2010


Calling for Republican Mefites?

Uh, I WAS a Republican until George Bush Sr. ran for President by courting the religious right. (Our state convention that year was completely swamped by brand new Pat Robertson Republicans. Little did we know the takeover would be forever.) I have been an Independent now for nearly 25 years, though until George W Bush I had hopes that there might eventually be a spot for moderates and liberals again in the R party. I strongly supported Obama for President and still count myself as a strong supporter, but I don't identify as a Democrat and likely never will.

So, as a former R, I can tell you that watching these shenanigans has made me tell my husband that I am never, ever going to be one again.
posted by bearwife at 10:32 AM on March 24, 2010 [1 favorite]


I kinda wish my nickname was "the Cooch."
posted by mrgrimm at 11:36 AM on March 24, 2010 [1 favorite]


So, The Cooch is a teabagger?
posted by dirigibleman at 12:50 PM on March 24, 2010


Here's an issue...

The bill that was signed on Tuesday contains the following two stipulations:

(a) State Opt-out of Abortion Coverage-
(1) IN GENERAL- A State may elect to prohibit abortion coverage in qualified health plans offered through an Exchange in such State if such State enacts a law to provide for such prohibition.

and

(i) REQUIREMENT- Notwithstanding any other provision of law, after the effective date of this subtitle, the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are--
(I) created under this Act (or an amendment made by this Act); or
(II) offered through an Exchange established under this Act (or an amendment made by this Act).

So.... Lets assume that there will be some states that decide to prohibit plans that abortion coverage from being in the exchange. Doesn't this mean that congressional staff and members of congress from those states won't be able to buy insurance that covers abortion, regardless of whether they want to do so? Ok, I guess not. They'll just have to buy (supplemental) abortion coverage or full coverage that includes abortion on the individual (albeit, non-exchange) market, right? That should be interesting if which insurance they're buying ends up being public information.

Also, Obama always stumped about how all American citizens should all be able to use the same (public) insurance that he and members of congress use. Which insurance is this, exactly? And, is it "created under this Act" or "offered through an Exchange?" (It couldn't be the latter, could it?) If no, then are they even going to get to keep using the insurance that they're using now?
posted by sentient at 12:58 PM on March 24, 2010 [1 favorite]


Following the vote teabagger Mike Troxel posted what he claims to have believed was the home address of Rep. Thomas Perriello, who voted for the bill. Troxel urged his fellow teabaggers to harass Perriello at his home.

In fact, the address was that of Perriello's brother, who has four children under the age of eight. The evening following the publication of the address his lawn lights were stolen.

Today the FBI announced that it was investigating what appears to have been an attempt to kill or injure Rep. Perriello's brother or his family by cutting the propane lines for his gas grill.

Troxel has stated that he will not remove the address of Perriello's brother unless Perriello surrenders his own home address to the teabaggers.

Teabagger Mike Vanderboegh calls for Democratic party office windows to be broken across the nation. In several states teabaggers take this advice and have been breaking windows at Democratic offices.

Several Democratic Representatives have received death threats against them and their families. Sarah Palin's website publishes a US map with gun sights printed on locations of Democrats she wants to "target" for removal.
posted by sotonohito at 2:30 PM on March 24, 2010 [5 favorites]


Congratulations GOP - the tea party that you have embraced has taken over the news cycle as those crazy guys with bricks. Any appearances of a sane opposition to HCR have been erased, and God help you in November if something even more violent happens.
posted by Think_Long at 2:42 PM on March 24, 2010 [3 favorites]


http://prescriptions.blogs.nytimes.com/2010/03/24/the-public-option-resurfaces/

One potential strategy is to persuade a Democratic senator to put forward a public option amendment, but to force a vote on it only if Republicans succeed in making other changes to the reconciliation bill. If there were no other changes, the amendment would be withdrawn.

The senate started voting on amendments today. There are 33 of them listed (linked from here), none of which involve a public option. I wonder if a public option amendment can still be "put forward," as the NYT says.
posted by sentient at 3:31 PM on March 24, 2010


I'm really depressed that anyone would issue death threats against Representatives over this. How evil do you have to be?
posted by agregoli at 5:32 PM on March 24, 2010


Holy shit, this is awesome. Helen Thomas today asked Robert Gibbs about John McCain saying that the Republicans were going to stop trying to work with Democrats in the Senate (blargh). Gibbs answered:

MR. GIBBS: Well, yes, I find it curious that not getting your way on one thing means you've decided to take your toys and go home. I don't think -- it doesn't work well for my six-year-old; I doubt it works well in the United States Senate, because we have issues that are important for his constituents and for all of America.

Look, again, when it comes to financial reform people are going to have an opportunity to weigh in on behalf of the banks or on behalf of consumers. And I'll let their vote on that dictate which side of that ledger they feel most comfortable on.

Q Are you comparing McCain to a six-year-old?

MR. GIBBS: I'm saying that I think the notion that if you don't get what you want you're not going to cooperate on anything else is not a whole lot different than I might hear from a six-year-old.

posted by EarBucket at 5:50 PM on March 24, 2010 [12 favorites]


I disagree. My about-to-be six year old is more mature than the Senate Republicans right now. Although like them she's been known to scream how much she hates me from time to time.
posted by dw at 6:02 PM on March 24, 2010 [4 favorites]


"All politics in this country now is just dress rehearsal for civil war." -- Billy Beck, August 2009.

My God, Billy Beck hasn't ODed yet. I used to take the piss out of him regularly on alt.current-events.clinton.whitewater AKA alt.dead.horse.beat.beat.beat.

I should send him my home address so I can shoot him.
posted by Jimmy Havok at 11:28 PM on March 24, 2010


I seriously think he's the advanced pitch man for the administration.

Another Obama tactic shamelessly lifted from Bush/Cheney.


Oh no, you think those guys had an original bone in their bodies?
posted by Pollomacho at 4:40 AM on March 25, 2010


where they can afford to go off to Norfolk for the 60 days they are in session.

Not Richmond?


Yeah, Richmond. Multi-tasking failure on my part, sorry.
posted by phearlez at 9:26 AM on March 25, 2010


Oh man: the reconciliation bill has to go back to the House!

But after hours, the Republicans found two minor provisions related to higher education that violate Senate procedure. These provisions have to be removed from bill, and then it has to be voted on by the House again, said Jim Manley, spokesman for Senate Majority Leader Harry Reid.

It's the perfect time for a public option amendment... (well, kind of.)
posted by sentient at 9:42 AM on March 25, 2010


The CNN Breaking News Twitter account just posted their very first update on violence against Congressional offices:
House GOP No. 2: Someone shot at my office
The linked article starts like this:
Rep. Eric Cantor, the number two Republican in the House of Representatives, said Thursday that a bullet had been shot through a window at his district office in Richmond, Virginia. He also said he had received threatening messages.

He said he would not publicly release the messages out of concern that doing so would only incite further violence.

He also accused Democratic National Committee Chairman Tim Kaine and Rep. Chris Van Hollen of Maryland - a member of the Democratic House leadership - of "fanning the flames" of violence by using threats that have been made against Democratic members "as political weapons."

"Enough is enough," Cantor said. "It has to stop."
Unbelievable.
posted by grouse at 9:46 AM on March 25, 2010


Unbelievable.

It is, literally, unbelievable. The only way this sort of makes sense is if Tea Partiers either a) made a really stupid mistake and thought Cantor was a Dem or b) they're way crazier and more anti-government than anyone thought.
posted by oinopaponton at 9:53 AM on March 25, 2010


It is, literally, unbelievable.

Don't be so biased. Maybe Dick Cheney got lost on his way to a quail hunt.
posted by sallybrown at 9:59 AM on March 25, 2010 [1 favorite]


The unbelievable parts to me are that (a) CNN only decided it was "breaking news" when a Republican reported his office got shot at, and that (b) Cantor claims the cause of this is Democrats reporting the attacks against themselves "as political weapons" rather than the incitement by Republican politicians against "tyranny."
posted by grouse at 10:00 AM on March 25, 2010 [3 favorites]


just to clarify-- I don't think he's lying, just that it's incredibly weird that he's being all "Releasing my voicemails will start more violence!")
posted by oinopaponton at 10:04 AM on March 25, 2010


More of the same: Republicans are bullies trying to be disguised as victims.
posted by grubi at 10:18 AM on March 25, 2010 [9 favorites]


Gawker has an update on Cantor's claims:
Update: Hah.
A Richmond Police detective was assigned to the case. A preliminary investigation shows that a bullet was fired into the air and struck the window in a downward direction, landing on the floor about a foot from the window. The round struck with enough force to break the windowpane but did not penetrate the window blinds. There was no other damage to the room, which is used occasionally for meetings by the congressman.
Yep, just some health care reform-supporting enraged loony lefitst, wandering around Richmond, Virginia, firing guns in the air near buildings where the House Minority Whip has offices.

Update 2: Ok, we can stop referring to this as "Eric Cantor's office."

Eric Cantor's Richmond office is in Glen Allen, north of Richmond. This terrifying gun attack happened at an entirely different building that Cantor's direct-mail firm is located in. So this liberal shooter really did his homework, firing into the air in such a fashion that the bullet would come down and break a window in an office building that isn't actually Eric Cantor's office, but one that he occasionally takes meetings in. A lotta research went into this!
posted by grouse at 4:03 PM on March 25, 2010 [7 favorites]


In this story about a package delivered to Rep. Weiner containing a harmless white powder and a letter telling him to drop dead, NBC reports:
The House's No. 3 Republican, Eric Cantor of Virginia, said at a brief news conference Thursday that someone fired a bullet through a window of his campaign office in Richmond this week and he has received threatening e-mails.

Responding to Democrats who have accused Republicans of being too slow to condemn the attacks against lawmakers, he stressed that security threats are not a partisan issue. "To use such threats as political weapons is reprehensible," he said.
Right so 1) It wasn't his office, 2) The bullet was not fired through the window, 3) To talk about the attacks on Democrats AS attacks on Democrats is "reprehensible" because as we all know there is no difference between Republican Congressmen and Democratic Congressmen. After all, didn't they all just vote for a massive new Health Bill?
posted by Secret Life of Gravy at 5:05 PM on March 25, 2010


As an update to my earlier post linking to David Frum's blog entry about the winners and losers in the #hcr "waterloo," it looks like he's received so much heat for his opinion, he's stepping down from his position as a resident fellow at the American Enterprise Institute, a conservative think tank, though there are denials that the two events are related. Others have claimed, though, that there's a history of scholars being forced to leave AEI if they become too public with their opinions.
posted by crunchland at 6:38 PM on March 25, 2010


David Frum is a bastard and an embarrassment, and I apologize on behalf of all Canadians for his presence in your country.
posted by five fresh fish at 7:09 PM on March 25, 2010


It is, literally, unbelievable. The only way this sort of makes sense is if Tea Partiers either a) made a really stupid mistake and thought Cantor was a Dem or b) they're way crazier and more anti-government than anyone thought.

It's the tea partiers, the correct answer is always crazier than anyone thought.
posted by afu at 7:16 PM on March 25, 2010 [4 favorites]


The AEI firing Frum is actually kind of shocking. This is how a movement dies.
posted by EarBucket at 8:10 PM on March 25, 2010 [1 favorite]


David Frum is a bastard and an embarrassment, and I apologize on behalf of all Canadians for his presence in your country.

As you might expect I disagree with every single thing he believes; I also believe that he's sane. You could argue with David Frum, you could discuss things, you could recognize that you are different sides of a question, and you would still be both inhabiting the same... plane of reality.

Those other folks? Damned if I know what world they live in.
posted by jokeefe at 10:18 PM on March 25, 2010 [3 favorites]


House passes final bill. The senate reconciliation package was slightly different then the house version, so they ended up needing a second vote, which just went down tonight. So now all the voting is done.
posted by delmoi at 11:11 PM on March 25, 2010 [1 favorite]


David Frum is a bastard and an embarrassment, and I apologize on behalf of all Canadians for his presence in your country.

Yeah, you've got enough liberal Democrats already.
posted by philip-random at 11:22 PM on March 25, 2010


I also believe that [Frum]'s sane.

On the other hand, he's shamelessly dishonest. During the Bush administration, he peddled completely debunked talking points with smooth confidence, with not a hint of unease in his voice.

I'd rather have an honest crazy person than a person who shares my reality but is trying to persuade people of an utterly false one.
posted by Jimmy Havok at 2:00 AM on March 26, 2010 [2 favorites]


"Odd how Democrats have to be both the liberals and the conservatives these days."
posted by saulgoodman at 9:05 AM on March 26, 2010 [1 favorite]


A preview of what's to come next out of corporate-land in response to HCR:

AT&T Whines Like a Baby Because Health Care Reform Also Eliminated One of Corporate-America's Favorite Tax Loop-Holes; Dim-Witted Day-Traders on MarketWatch Comment Board Warn of Creeping Socialist Conspiracy.
posted by saulgoodman at 12:51 PM on March 26, 2010


A preview of what's to come next out of corporate-land in response to HCR

Oh man, we haven't seen anything yet. The corporate propaganda around HCR this fall should be insane.
posted by mrgrimm at 3:23 PM on March 26, 2010


While I'm not a fan of tax loopholes, I wasn't particularly keen on the proposals to tax health care benefits for workers. I'm usually all for doing whatever we can to milk the last drop of blood out of these corporate fuckers.

Unfortunately, I think removing deductions from the plans disincentivize the companies from offering good benefits. I hate to sound like a dickweed republican. But honestly? The AT&T thing I'm a bit sad.

Can someone show me how taxing the benefits is good instead of finding some other way that won't hurt people benefiting from the benefits?

Maybe they're threats about removing bennies from retired workers is just a bunch of bluster, and if it is, great... But if it's not?

I dunno I'm just so peeved about this bill. It's got good elements that I can really get behind, but there is so much corporate bullshit in there all in the name of "compromise" that nobody but the centrist dems forced to compromise... And some of that is the very same shit that is pissing people off left and right. And of course, this lets the right call it "socialism" even though it's not. Meh.
posted by symbioid at 4:19 PM on March 26, 2010


Ecpecially now that the corporations can spend as much as they want to campaign against it and the folks who voted for it.
posted by darkstar at 4:19 PM on March 26, 2010


I think the trick to HCR is to make sure the Dems stay in power a few more years, and to encourage your reps to start closing the loopholes. What's happened this past week is not the end: it is only the beginning of what needs to be done.
posted by five fresh fish at 4:50 PM on March 26, 2010 [2 favorites]


symbioid wrote: "Can someone show me how taxing the benefits is good instead of finding some other way that won't hurt people benefiting from the benefits?"

It's an incremental improvement towards the end of giving health benefits a special status in the tax code. That special status is what set the whole pile of horse manure in motion.
posted by wierdo at 9:53 PM on March 26, 2010


symbioid: "Can someone show me how taxing the benefits is good instead of finding some other way that won't hurt people benefiting from the benefits?"

The "Cadillac tax" will only impact insurance plans that cost more than $27,500/year for a family (the average plan costs about $13,500 for a family). The only part that is taxed (starting in 2018) will be the portion over $27,500. That tax will be 40% of that amount - so a plan worth $28,000 will be taxed on the $500 excess, or a $200 tax. That tax will likely be paid by the employer.

The best insurance I've ever had was through Microsoft. No premiums, no co-pays, exceedingly generous benefits lumped under "health insurance". Beyond generous. Even that plan, IIRC, was valued under $27K/family each year. I think that the plans that are taxable will be few and far between. The tax is meant to be an encouragement to find a more cost-conscious insurance plan, not necessarily to penalize the actual policy holder.
posted by Lulu's Pink Converse at 11:23 PM on March 26, 2010


Grr. As an orange badge I was more than a little envious of that, and all the other shit you guys got.
posted by Artw at 11:37 PM on March 26, 2010


Unfortunately, I think removing deductions from the plans disincentivize the companies from offering good benefits. I hate to sound like a dickweed republican. But honestly? The AT&T thing I'm a bit sad.

The tax that they are all taking charges for is a credit that they used to get for offering prescription drug benefits to retirees. They still get to deduct the cost of the benefits. Before they got to double dip - take the credit and take the deduction. Now they are crying that their corporate welfare was taken away. Remember it's socialism when the government gives to poor people and capitalism when they give to corporations.
posted by caddis at 6:12 AM on March 27, 2010 [4 favorites]


Thanks for explaining the tax thing -- it really bothered me that somehow I was siding with corporations.
posted by symbioid at 8:14 AM on March 27, 2010


Artw: "Grr. As an orange badge I was more than a little envious of that, and all the other shit you guys got."

Yeah, that shit was fabulous. We miss it now that we don't have it any more - hint, that giant internet retailer in Seattle? Has crap benefits in comparison. Someday, my husband may have to go back across the lake, just for the benefits.
posted by Lulu's Pink Converse at 9:51 AM on March 27, 2010


Grr. As an orange badge I was more than a little envious of that, and all the other shit you guys got.

Yeah, that shit was fabulous. We miss it now that we don't have it any more - hint, that giant internet retailer in Seattle? Has crap benefits in comparison. Someday, my husband may have to go back across the lake, just for the benefits.


Psst... a few of us are only still working at a very large research and teaching university in the Puget Sound area because of the Uniform Medical Plan. Yeah, it's now $250/person deductible and 15% out of pocket in network, but almost every doc in town takes it. If you're willing to tolerate the low salaries, the benefits are ridiculous.

posted by dw at 10:40 AM on March 27, 2010


The official Republican talking point: it's a "Health Spending Bill" and it costs a lot more than anyone who actually has done the math says it does.

Talking point two is that the American people are all against it, no matter what the polls say. Because if you aren't against it, then you aren't really an American.
posted by Jimmy Havok at 3:39 PM on March 27, 2010


Republicans don't believe America can do what every other industrialized nation has done.

Though to be honest, the truth is probably that Republicans can't do what every other industrialized nation has done. The party is pretty incompetent at doing actual good and useful things, all in all.
posted by five fresh fish at 4:45 PM on March 27, 2010 [1 favorite]


The rage is not about health care.
posted by caddis at 10:14 PM on March 27, 2010 [7 favorites]


The rage is not about health care.

Summarize, please. It's Saturday night here in the western world and some of us can't really focus that well.
posted by philip-random at 11:55 PM on March 27, 2010


From the article:
The real source of the over-the-top rage of 2010 is the same kind of national existential reordering that roiled America in 1964.
...
The conjunction of a black president and a female speaker of the House — topped off by a wise Latina on the Supreme Court and a powerful gay Congressional committee chairman — would sow fears of disenfranchisement among a dwindling and threatened minority in the country no matter what policies were in play. It’s not happenstance that Frank, Lewis and Cleaver — none of them major Democratic players in the health care push — received a major share of last weekend’s abuse. When you hear demonstrators chant the slogan “Take our country back!,” these are the people they want to take the country back from.
posted by darkstar at 12:29 AM on March 28, 2010 [3 favorites]


five fresh fish wrote I think the trick to HCR is to make sure the Dems stay in power a few more years, and to encourage your reps to start closing the loopholes.

"Stay" in power? They're already out of power, the 41 vote Republican majority ended Democrat power in Washington.

As long as the Republicans retain their 41 vote majority there is absolutely no possibility of any loopholes being closed, they can, and will, filibuster anything the Democrats propose. At this point they might as well just shut down Congress until the next election, because ain't nothing getting through the Senate.

I'm not sure, really, what can can be done. The Democrats, even after all this, refuse to put any serious effort into ending the filibuster, and with the Republicans playing by Westminster rules that means 41 votes really is an effective majority (at least when it comes to stopping things) in the Senate. I really, seriously, doubt the Democrats will get back even the nominal 60 vote supermajority they held until Brown.

Worse, while it's easy to make fun of McCain's comments about the Republicans beginning to withhold cooperation from this point forward, the fact is that they didn't really filibuster absolutely everything this past year, but I do expect them to do pretty much just that from now until November at the very earliest.

In a way I think that's good. Absent some genuinely insane levels of opposition from the Republicans, I don't think the Democrats will ever do anything about the filibuster. If we can't get rid of the Senate (and, regrettably, that ain't going to happen for a very long time if ever), but at least we might be able to get rid of the filibuster if the Republicans keep this sort of crap up.
posted by sotonohito at 2:56 PM on March 28, 2010


Now the FBI has arrested someone who issued death threats against Cantor. Is this connected to the previous bullet?
posted by grouse at 9:53 AM on March 29, 2010


Now the FBI has arrested someone who issued death threats against Cantor. Is this connected to the previous bullet?

From your link: "Police have said their investigation indicated the bullet was a stray from a randomly fired handgun."

So, it looks like there was no bullet fired at Cantor's office at all.
posted by Pollomacho at 11:37 AM on March 29, 2010


Yeah, that shit was fabulous. We miss it now that we don't have it any more - hint, that giant internet retailer in Seattle? Has crap benefits in comparison. Someday, my husband may have to go back across the lake, just for the benefits.

The retailer has a really neat store where you can buy all kinds of nearly new stuff they took out of the box to photograph at insanely low prices. That's where we got our strollers and a ton of baby stuff.

posted by Artw at 11:44 AM on March 29, 2010


So, it looks like there was no bullet fired at Cantor's office at all.

Hey, at least it's a bullet and not, say, a rock or some air or something.
posted by Artw at 11:44 AM on March 29, 2010


Hey, at least it's a bullet and not, say, a rock or some air or something.

True, but I love the irony of the fact that Cantor's office was not struck directly by an attacker, but rather the unfortunate consequences of civilian gun ownership.
posted by Pollomacho at 12:20 PM on March 29, 2010


Me, I'm wondering whose going to speak out to defend all those militia types who Obama is rounding up to put in his healthcare camps.
posted by Artw at 12:21 PM on March 29, 2010


You mean like these guys?
posted by Pollomacho at 12:35 PM on March 29, 2010


It wasn't even Cantor's office, but the office of a company hired to do something or other. Essentially Cantor made the story out of wholecloth.
posted by five fresh fish at 12:51 PM on March 29, 2010 [1 favorite]


Under the health care overhaul, young adults who buy their own insurance will carry a heavier burden of the medical costs of older Americans — a shift expected to raise insurance premiums for young people when the plan takes full effect.
posted by homunculus at 11:10 AM on March 30, 2010


Two important lines in that story.

The analysis did not factor in tax credits to help offset the increase.

and

The analysis, conducted for The Associated Press, examined the effect of the law's limits on age-based pricing, not other ways the legislation might affect premiums, said Elizabeth McGlynn of Rand Health. [emphasis mine]

One important factor in that second bit is that the new law mandates that a certain percentage of premiums be spent on medical care (80% in the small market) AND the creation of exchanges which will further eliminate some fat.

Without reading the basis for the analysis itself we also don't know if it's computing based on a larger enrollment of the young or assuming identical enrollment to now. With the cover-till-26 provision and the mandate there should be more of these folks spreading the impact of the reduced multiplier.
posted by phearlez at 1:48 PM on March 30, 2010


Sanction the 18 state Attorney Generals
posted by caddis at 11:35 AM on April 14, 2010 [1 favorite]


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