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February 17, 2010

Comments

Honestly I think they were never capable of passing anything substantial anyway. With or without Evan they are just to deeply invested in the status quo to want change

Lindsay,

I share your frustration totally. The Congressional Dems need to get aggressive, pass bills or die trying, and deal with the consequences later.

It's important to ask why they won't do that. I don't know the answer, but a general passivity on their part and Obama's seems to be a big part of it. Maybe you can't change the tone in Washington and change the country at the same time.

Reid looks like he's gone in November. I hate to lose the seat, but am glad to get rid of Reid. Can we have a leader with a secure seat and a spine, please? No Daschle, no Reid. That, and an aggressive stance by Obama, would make a huge difference, ISTM.

As for Obama, well, FDR wasn't interested in changing the tone, or trying to accommodate Martin, Barton, and Fish. He wanted action, and Obama might take that as a useful example.

And Bayh left with a parting shop giving credence to GOP talking points.

I fear that was ambiguous wording. He seemingly conferred credibility to GOP talking points.

Evan Bayh spent his political career afraid that he would share the same fate as his father, Birch Bayh, who was displaced by Dan Quayle in a Republican sweep election. He tailored his entire career in such a way to avoid that fate, by playing not only the moderate but actively playing to the "middle" of whatever political dispute was at hand. It was his job to be the Democrat who would side with the Republicans at the crucial moment. And this was to ensure that he would keep his seat in Indiana and perhaps one day run for president as a "moderate centrist."

And what happened? He did all of that, and he helped torpedo health care by lending credibility to the Ben Nelsons and Joe Liebermans who were trying desperately to water down reform any way they could. Maybe if he had become a champion of reform and maybe if he had provided "moderate Democratic cover" by supporting full-throated health care reform (marginalizing other "moderates"), the measure wouldn't have hit so many road blocks. And maybe that would have cost him his seat in the Senate in 2010...

... but he'd be no worse off than he is now, and the Senate would have accomplished something.

Would it have really been that much worse for him to stick his neck out for Democratic party causes and then risk losing his seat in a future Republican sweep election? Does he really feel better about himself by simply deciding to quit/retire when his "doctrinaire centrism" song & dance simply wasn't doing anything anymore? How is this outcome for him so much better than his father's political fate?

Bayh was worthless. Worse than worthless, he worked actively to sabotage Democratic agendas--largely by dint of being one of the most bought-and-paid-for Democrats in the Senate.

So long as we can maintain our majority, I think this is a net gain for us. Bayh did far, far more damage from within our caucus than any given Republican in his seat would by being just another of the 40-something Republicans stubbornly saying "no" all the time.

Mind you, I'm of much the same opinion about Nelson and Lieberman. These people are malignant and corrupt and need to go. So long as we keep our Senate majority, any number above 50 is meaningless unless we have 60 Senators willing to support the party on procedural votes even if they intend to vote against the legislation. And this is how it will remain without filibuster reform.

So yeah. Good riddance. It'd be nice if we could keep the seat, and depending on who the IN party nominates we might just do that. But I'd also be satisfied with one less conservative in our caucus actively working against us, whose only Democratic quality is the letter beside their name.

Given the number of spineless, wishy-washy Dems still amoeba-ing their way through both houses, I don't see the point of beating up a guy who walks away and gives a fairly truthful reason for his exit. For good or ill, he's right about the sad condition of our government and the utter lack of statesmanship therein.

Maybe the Dems will wake up - but I won't be betting the farm or even the compost pile, on it.

"As for Obama, well, FDR wasn't interested in changing the tone, or trying to accommodate Martin, Barton, and Fish. He wanted action, and Obama might take that as a useful example."

The problem with carrying through with that example is that it would require leadership.

I do not question his smarts one bit, a hugely needed antitode to George Bush's eight years of dumbing-down America.(Is it possible to be too smart for you own good sometimes?) But I find President Obama to be terribly deficient in leadership.

Also, while it would be foolhardy to discard whatever lessons there are to be learned from the Scott Brown victory, I get the sense that this White House is now becoming poll-driven, which would continue to deprive it of any chance to be special.

We'll see.

"Would it have really been that much worse for him to stick his neck out for Democratic party causes and then risk losing his seat in a future Republican sweep election?"

I don't know Evan Bayh but I find the complaints about him very similar to the complaints about Specter, and maybe lots of others. I don't think his job is to stick his neck out for Democratic party causes anym re than it was Specters to stick his neck out for Republican causes.

The very tone of this comment is fundamental to why our government really hasn't accomplished much, we expect people to do what the party leadership decides and if they don't , we really punish them.

Democrats aren't as good at this, that's a good thing, but it doesn't mean they don't do it. It is without a doubt the biggest problem we have that we no longer accept the outcome of representative democracy, and we trained our politicians to practice referndum democracy or get out.

Marty, or he could have become a Republican, if he really truly believed in all of that.

The truth is that Bayh was most comfortable being "the Democrat that crosses party lines to help out Republicans." With the Democrats in control of the Senate, he really had nothing to do.

But my original point was that Bayh was always playing the role of the centrist's centrist because he was in morbid fear of being seen as "too liberal" and losing his seat, like his father did. But unlike his father, he didn't accomplish much and ultimately he is no better off than he would have been had he lost the 2010 election.

...but he's who Indiana voted into office, so they must like that kind of thing.

They also liked Richard Lugar, who wasn't exactly a mainstream Republican.

s/wasn't/isn't

"Marty, or he could have become a Republican, if he really truly believed in all of that."

No, no, no, no, the Democrats have the big tent. From centrists and moderates to the very far left, they are the party of the people, not the rich and powerful, until they win. They win by creating the most unmanageable of coalition governments.

The breadth of who they represent would almost never get a coalition formed in a parliamentary government. If they did it would be fragile and everyone would recognize how difficult it would be to pass any meaningful legislation. Since we call them all Democrats no one seems to think through that fragility.

Bayh is the effect of believing you can represent that broad spectrum of people and act like they all agree, or should all agree. It just isn't realistic.

So, when the Democrats win, they immediately start losing, because they can't possibly protect the left from the middle and get anything done. So they quarrel internally and look ineffective to the public.

Then they try to blame their inability to govern on the Republicans, who win by doing nothing except issuing a Mount Vernon Statement or a Contract for America that makes it sound like they are at least all for the same thing.

Then they try to blame their inability to govern on the Republicans...

Marty,

Have you seen the numbers on the use of the filibuster? They are dramatic if you haven't. Basically, the GOP has abused the filibuster in a totally unprecedented manner.

Further, the GOP has put more holds on Obama appointees than at any time in the past.

Don't you think that's at least PART of the story?

The Road to 55. And its a good road.

Let's face it the Road to 60 was simply a snare for Progressives. It essentially gave a Get Out of Jail Free card to Republicans because any successful filibuster could simply be chalked up as a failure by Reid to get the 60th vote from his own caucus. Whereas a bill that goes down because 53 of 55 Dems voted for it and 45 Rep plus tow Dems voted to oppose cloture is clearly on the hands on the opposition.

Was 60 votes better than 59? Arguably yes. Is 59 votes better than 55? Not necessarily, it depends on the four votes you lose. I am a Yellow Dog of long standing, if I was living in Arkansas and Blanche Lincoln was my only Democratic choice then of course I am going to vote for her. That doesn't mean crying if she lost.

And for that matter while I think that Reid is well-intentioned and to some degree simply a prisoner of the institution, we have to remember that when LBJ was Majority Leader and later President he was working with a much larger number of Conservadems/Dixiecrats and still got things done. His method was called 'The Johnson Treatment' and visually looked like this:
http://3.bp.blogspot.com/_fjW71B3WLTQ/Sp1ETNlLK6I/AAAAAAAAASM/B1HG0ZLjqEc/s1600-h/Johnson+Treatment.jpg

Losing Bayh, LIncoln and even Reid's seats would be on net a negative. Probably. But the result would be a more cohesive and stronger caucus, and maybe one where someone at least pretended to listen to Progressives.

Eric,

Every successive Congress for the last thirty years has used the filibuster more. The Democratic Senate under Bush used it more than any previous Senate (until they didn't need to). I would point out that it is a cause and effect relationship. The more you try to rapidly pass legislation that advances a particular parties agenda with little regard for the other party, the more you will get a filibuster.

In the past, administrations would float things that the opposition said were dead on arrival so they didn't push it to bills.

The one thing this Congress has done is just churn out legislation, one sided and completely partisan, push it through the House and dare the Republicans to filibuster it. So they have.

There are two sides to every story, also a cause and effect. In the end, the measure is how many pieces of significant legislation gets passed compared to previous Congresses and that number is probably not down a lot.

Marty,

They've voted against their own bills! They've argued against their own initiatives. They've criticized tax cuts!

There are two sides to every story, but you're missing the truth - which isn't so even-handed. From this post:

"Some senior Republican strategists and party veterans are beginning to fret that the party's refusal to work with President Obama, even when he crosses onto their own philosophical turf, could ultimately erode some of the political gains they've made this past year.

Over the past two weeks, Republicans in Congress have united in nearly unanimous opposition to a series of ideologically conservative policy suggestions, starting with a commission to reduce the deficit, a pay-go provision that would limit new expenditures, and a spending freeze on non-military programs.

Opposition has usually been based on specific policy concerns or complaints that the measures aren't going far enough. But the message being sent is that the GOP's sole mission is presidential destruction.

Now, some in the party are beginning to worry."

That post, I should remind you, was citing a Daniel Larison piece appearing on The American Conservative magazine's blog.

Larison criticized this practice. If you're looking for reasonable Republicans, I'd say forget Gingrich and look to people like Larison.

Every successive Congress for the last thirty years has used the filibuster more.

No, it's not even close.

The one thing this Congress has done is just churn out legislation, one sided and completely partisan, push it through the House and dare the Republicans to filibuster it. So they have.

Bollix. Obama offered pay-go. Tax cuts. Spending freeze. The GOP: NO!

They don't want to lead, or even allow votes. They want to obstruct everything. Even historically GOP-supported policies.

The one thing this Congress has done is just churn out legislation, one sided and completely partisan, push it through the House and dare the Republicans to filibuster it.

When crafting the health care legislation, Obama invited Boehner and the GOP leadership to the White House, and asked them what they wanted in the bill. They gave him their top 4 priorities. The Dems included them in the bill. The GOP's response? Filibuster.

"Every successive Congress for the last thirty years has used the filibuster more.

No, it's not even close.

The one thing this Congress has done is just churn out legislation, one sided and completely partisan, push it through the House and dare the Republicans to filibuster it. So they have.

Bollix. Obama offered pay-go. Tax cuts. Spending freeze. The GOP: NO!"


Just to get this out of the way:

The filibuster has tremendously increased in frequency of use since the 1960s. In the 1960s, no Senate term had more than seven filibusters. One of the most notable filibusters of the 1960s occurred when when southern Democratic Senators attempted, unsuccessfully, to block the passage of the Civil Rights Act of 1964 by making a filibuster that lasted for 75 hours, which included a 14 hour and 13 minute address by Robert Byrd (D-WV).[38] In the first decade of the 21st century, no Senate term had fewer than 49 filibusters. The 1999-2002 Senate terms both had 58 filibusters.[39] The 110th Congress broke the record for cloture votes reaching 112 at the end of 2008,[40][41][41] though cloture votes are increasingly used for purposes unrelated to filibusters.[28]

Always polite to link your sources, Marty.

Um, Marty, what do you think that chart proves?

Your point, or mine? Looks to me that after the Dems took over the Senate, filibusters spiked. Right?

Eric,

I have been accused of being duped, wrongly, by Bush. I will say that I have ha dthe discussion multiple times with my very most intelligent friends ( much smarter than this country bumpkin) AND AM AMAZED THAT THEY BELIEVE EVERY THING THIS SHYSTER SAYS.

I will go back almost a year to what I said about bipartisanship at the time.

When you call the Republican leadership to the WH and tell them what you are going to do so that they have a chnace to agree, that isn't bipartisanship. He is now doing it again, releasing a bill that he wants passed and then calling a bipartisan summit to give them the chance to agree or change it around the fringes.

He has the right to do all those things, but they have a right to be just as partisan in return.

I understand Larison and agree that at some point they have to pass something and take credit for it.

The assumption that somehow they should suddenly not be Republicans or Conservatives anymore is just wrong. They should start to pass small meaningful things he is suggesting.

When you call the Republican leadership to the WH and tell them what you are going to do so that they have a chnace to agree, that isn't bipartisanship.

No!

He included non-Democratic provisions requested by the GOP in the actual HCR bill itself.

Further, pay-go was supposed to be a GOP bill. If he tries to pass that, how is he being partisan? How is he not taking them into account? How is he ramming down the throat?

Also, the budget reduction panel?

Also, the tax cuts for small biz?

Please refer to the linked post.

Sorry Slart, certainly meant to add the link, thanks for the help.

Marty, GOP requests for HCR:

BOEHNER: Number one: let families and businesses buy health insurance across state lines.

MADDOW: Check. As Ezra Klein of the “Washington Post” points out, the Senate version of the health reform bill actually allows for that. There‘s a whole section relating to the offering of plans in more than one state. Individual states can band together and allow insurers in one of those states to offer plans in all of those states, buying across state lines is in the bill.

BOEHNER: Number two: allow individuals, small businesses and trade associations to pull together and acquire health insurance at lower prices, the same way large corporations and unions do today.

MADDOW: Check. That‘s exactly what the proposed health insurance exchanges are all about. The more people that are allowed to participate in these exchanges, the greater the risk pool becomes and the lower the costs get. So, they‘re two-for-two with the second Republican demand already in the bill.

(BEGIN VIDEO CLIP)

BOEHNER: Number three: give states the tools to create their own innovative reforms that lower health care costs.

MADDOW: And I‘m beginning to sound like a broken record here, but check—also in the bill. Section 1332 of the Senate bill is called the “Waiver for State Innovation.” Again, as Ezra points out, it allows states to opt out over the whole shabang if they can prove they have a better and cheaper way to do it.

So, the first, second and third of the four Republican demands on health care are all in the bill.

How about their last one, number four?

(BEGIN VIDEO CLIP)

BOEHNER: And number four: end junk lawsuits that contribute to higher health care cost.

MADDOW: Otherwise known as tort reform, otherwise known as in the bill. Yes, the Senate bill calls on individual states to develop new ways to deal with malpractice lawsuits—alternatives that could potentially be funded by Congress.

The Senate health reform bill addresses everything that the Republicans have identified as their main concerns for policy on health reform. And the Republican reaction is to say: the bill must be scrapped. Let me not put words in their mouths, let‘s them do it.

"The Senate health reform bill addresses everything that the Republicans have identified as their main concerns for policy on health reform"

Not so much the discussion below is from here that is indicative of how the reform bill "addresses" everythting:

How do the health overhaul bills approved by the House and Senate handle the issue of selling insurance across state lines?

The House would allow states to form health care "compacts" in which one state would allow their residents to buy coverage from an insurer based in another state. The states would determine which states' law applies to coverage sold through the compacts.

The Senate bill also allows states to form "compacts." But it would require that the coverage would be governed by the laws of the state in which the policies are "issued or written."

The Senate bill also would allow at least two insurers (one being a nonprofit) to sell multi-state plans in any state. The multi-state plans, which would provide coverage in the individual and small employer markets, would be supervised by the Office of Personnel Management, which oversees health benefits to federal employees. Under the legislation, the federal government would determine the minimum benefits the multi-state plans would offer. As a result, the minimum benefits could be more or less extensive than exist in some states. States could add more requirements to the plans though the states would have to bear the costs.


Essentially the bill allows the states to do something they could do today if they wanted to legislate it. Not so much the free enterprise that the Republicans thought would drive cost competition.

The state purpose of "buying insurance across state lines" was to allow small business owners and individuals to form very large risk pools so that individual sicknesses would not cause insurance premiums to skyrocket. That's what the Democratic proposal would allow. When this was actually proposed, the Republicans backtracked and complained that what they _actually_ wanted to do was just allow insurers to pick the lowest-regulation state to offer coverage from in order to bypass state laws.

So what happened was that Republicans were being disingenuous about their proposals and when Democrats offered a solution that solved the single-state-risk-pool problem, Republicans got upset.

What JustMe said.

Also, once again, one must remind oneself that Marty's purpose here is to serve as an annoying pest.

Must one?

One supposes one does what one has to do.

Marty, let's pretend that "the bill" does NOT contain any provisions the Republicans wanted. Is that really the reason they're filibustering it? Or is it that "the bill" contains provisions they OPPOSE?

I mean, you want the right to buy health insurance from a private company in South Dakota; I want the right to buy health insurance from the federal government. "The bill" does not contain either of those provisions. If I support "the bill" and you oppose it, the difference must lie in what "the bill" DOES contain. If you're willing to filibuster "the bill" (because it would pass if you did not) then your filibuster must be motivated by what's IN the bill, not what's left OUT of it.

--TP

we expect people to do what the party leadership decides and if they don't , we really punish them

I don't get this -- how was Bayh "punished"? He's stepping down voluntarily and will probably (1) stroke his ego with a presidential run (which will fail, but he'll receive no end of fawning praise from the Very Serious Centrists in the press, and then (2) embark on a seven-figure career lobbying for the corporate interests he's been duly serving in the Senate.

And every six months he can write a piece for the Washington Post about how sad it is that the elites in Washington can't put aside their ideologies and their bickering and their petty partisanship and realize that the answer lies not on the right, nor on the left, but exactly where Evan Bayh happens to be standing.

If that constitutes "punishment," all I have to say is that I've been a very, very naughty boy myself, and I need a good spanking.

TP,

Thats a good question and the real heart of the discussion. Fundamentally it is not the few things that are in or out that the Republicans objetc to, it is the trillion dollars worth of things the Democrats have in that they object to.

The proposals from the Republicans were to do JUST those things as a start and build HCR in steps. Having those things, in whatever acceptable or unacceptable form, in the bill is not the point.


Hopefully with none of the catch phrases from either side, the difference is in approach. So, if you start with the approach that looks like big government intervention the Republicans will be against it, the details matter very little. If you try to buyild it in steps over time the Democrats will be against that approach. The American people seem to favor the Republican approach.

They want many of the things in the current bills, they want a measured approach to getting them. IMHO

" That's what the Democratic proposal would allow."

It really is not what the proposal does. It doesn't reduce the cost of doing business for the states who have to administer all of these contracted relationships, and it doesn't reduce the cost to small businesses and individuals who have to buy in state.

It is simply a bill that says, "if you want to negotiate compacts across state lines with awprticular other states then its ok".

I am not sure they couldn't do that now.

The proposals from the Republicans were to do JUST those things as a start and build HCR in steps.

Unfortunately, doing JUST those things would have resulted in no net increase in the number of people covered. The fact that 15% of the people in this country have NO HEALTH INSURANCE AT ALL is one of the problems we need to solve. As far as I can see, they aren't offering a solution to that, other than the magic market pony.

And seriously, fillibustering the bill because it contains the stuff you want, but other stuff as well, doesn't really qualify as a good faith effort at compromise. In my book, anyway.

I get that Republicans are against expanding federal programs. It's a nice, principled position. But they're not solving anything, and haven't done so for quite some time, whether they've been in power or out.

"I get that Republicans are against expanding federal programs. It's a nice, principled position."

russell,

I agree that the other principled position is to cover all of the people somehow and the preference for single payer or a government option is a perfectly consistent part of that principled position.

I think that if the Democrats could have passed that position then they should have based on their principles. I think the Republicans should stop it if they can for the same reason. Bipartisanship is finding common ground. In this debate, the most fundamental approach is what is not in common.

We should not expect or want either party to support anything different. We should put that fundamental difference in front of the voters in 2010 and let them pick which way they want the country to go. How much one likes that solution depends greatly on whether they think their side will win.

Marty,

I don't know about you, but I want two things from health insurance: 1)must-issue, at standard rates, regardless of pre-existing conditions; and 2)must-renew, at standard rates, regardless of existing conditions. Without those two provisions, it's not insurance; it's an annual crapshoot, with the casino free to stop playing if I start to "win".

I would LIKE to insure everybody, I would LIKE to reduce everybody's premiums, I would LIKE to reduce federal deficits. Perhaps you'd like those things too. We can negotiate those later.

For now, I want to know whether you would support or oppose a small, straightforward bill that contains ONLY the two provisions I list in the first paragraph.

If you'd support it, great: let's pass that first and work incrementally from there. If you'd oppose it, I'd like to know on what grounds.

--TP

TP,

Yes I would. I believe it is a great starting place. Lets clarify that standard rates are the ones approved by the individual states current methods and pass it.

Okay, Marty, we're on.

Now, how do we counter the immediate objection from the insurance companies that our bill would immediately result in people only buying insurance AFTER they get sick?

--TP

Yes I would. I believe it is a great starting place. Lets clarify that standard rates are the ones approved by the individual states current methods and pass it.

Without a mandate, wouldn't guaranteed issue destroy the insurance industry? I mean, under this system, why should people pay for insurance until they're sick? Now, if you want to destroy the private insurance system, this is a good way of doing it, but I don't think you want that....

What Turbo said, and also why the "let's do hcr in pieces" argument is either based on good faith ignorance or bad faith.

You have to increase the pools to lower costs, and the only way to increase the pools is to either cover everyone automatically with a default coverage, or make them buy-in to the coverage of their choice.

"Now, if you want to destroy the private insurance system, this is a good way of doing it, but I don't think you want that...."

:) I knew that was coming, but I don't think it would destroy anything. Chicken little, again it only applies sto the 10-17 million people buying individual insurance. Anyone with employer based insurance already has this.

And, btw, it might be reasonable to have some limits on required coverage all around. These are other things you might want to do in the second bill, for example. Funny though, I bet if you got that first bill passed their would be a second one.

There are currently approx 35-40 million that don't have insurance in America. Further, it would apply to new waves of uninsured annually. Further still, employers would begin to drop coverage considering that they wouldn't be offering anything special.

Finally, the losses would be massive if people waited until they were sick to buy insurance. The payouts would not be offset by earlier expenditures.

Wouldn't work, and that ain't chicken little.

Anyone with employer based insurance already has this.

Not really. Tenured professors aside, nobody is guaranteed employer-based insurance, because nobody is guaranteed employment.

And Marty: I'm not sure how to parse your last paragraph.

--TP

"And, btw, it might be reasonable to have some limits on required coverage all around. These are other things you might want to do in the second bill, for example. Funny though, I bet if you got that first bill passed their would be a second one"

Not surprised you cant parse this, written hastily.

The point, completely unclear, is that the things that the Republicans wanted to start with: interstate acquisition, state based exchanges, etc. addressed these things.

Eric's right that the way you put it (bad read on my part, I assumed you were talking about taking away recission for existing insured) adds 30-40 million, same answer though. Everyone should have access to a base level of insurance, period.

Problem is that in the one fell swoop method we didn't get to that anyway. I am not sure why anyone wants this bill passed. It doesn't cover everyone, it doesn't control costs, it doesn't pay for itself.

I would rather pass your two line bill and add that the government will insure against losses for the first year that someone with a preexisting condition is insured than what we have in this bill.

Always, keeping in mind that I wanted a simple bill that expanded Medicare to the uninsured with a very simple subsidy structure. Outlaw private recission and work on cost reductions in another bill.

So I am not the best person to defend the Republican position except to defend their right to have it on principle.


You have to increase the pools to lower costs ...

Eric, I know that's short-hand, but I'm not sure it's right even as short-hand. I've never run an insurance company, so my view may be terribly simple-minded. But here it is anyway:

If I'm collecting premiums from a million people, and paying medical expenses for that million people, the aggregate premiums must cover the aggregate expenses. (Assume my own vigorish is negligible.) My million-person customer pool has, let us say, an average medical expense of $700 per month.

If I increase my pool by another million people who have the same average monthly medical expense, how can I reduce anybody's premium?

Now, if I can add a million customers whose average monthly medical expense is less than $700 per month, then I can indeed lower my premiums. Say, my second million customers cost $500/mo; then I can set the premium for all two million customers in my pool at $600. But why would that second million people buy into my pool?

Incidentally, I use $700 per person per month in my example because US "healthcare spending" is in fact about $700 per person per month: $2.5 trillion, divided by 300 million, divided by 12.

The trouble, I think, is that there are two ways to define "insured". One way is: you're insured if your medical bills are covered. The other way is: you're insured if you're paying insurance premiums. To want universal coverage is to want everybody paying premiums.

As a matter of fact I do want that, and I want to subsidize the premiums of people who cannot afford them. But I'm perfectly willing to concede that this means requiring the young and healthy who can afford it to pay premiums whether they want to or not. I'm willing to concede that because I actually do believe it's for their own good: they won't be young and healthy forever.

I'd be willing to let those people opt out of insurance -- but only if I was willing to let them die in the steet should they someday be old, sick, and poor. But I'm not willing to do that, so there:)

--TP

"You have to increase the pools to lower costs ...

Eric, I know that's short-hand, but I'm not sure it's right even as short-hand."

In addition, if the Democrats position is accurate, we are already paying massively for those people to be treated in the most inefficient manner, only when they get sick. So we move that cost from the hospitals etc, to the insurance industry the net should be lower overall costs thus, at least, making the insurance company whole.

If I increase my pool by another million people who have the same average monthly medical expense, how can I reduce anybody's premium?

Tony, you'd have the potential for lower costs of treatment, because greater volume means greater leverage when you're negotiating with the providers. Medicare can pay less to providers than most insurance companies, because those providers don't want to forgo a huge pool of potential patients.

That's my understanding of it, anyway.

Tony P.,

But I'm perfectly willing to concede that this means requiring the young and healthy who can afford it to pay premiums whether they want to or not. I'm willing to concede that because I actually do believe it's for their own good: they won't be young and healthy forever.

Me too. Because it's the only way to make sure that everyone can get insurance.

And no, it's not an unfair imposition on healthy people. There are two non-exclusive ways to look at this.

First, young healthy people (YHP's, for short) are buying two things: insurance, and an option to be able to buy insurance in the future at reasonable rates. The second may be worth more than the first.

Second, YHP's are spreading their lifetime health insurance costs out, so that they pay more than "they should" now and less than "they should" later.

Beating my usual drum, there is no reason to think that health insurance premiums should be actuarially fair over short periods of time - a year or two. They have to be fair over a lifetime, but that allows a lot of room for moving payments around in time, and doing that is probably a good idea. That's part of what "overcharging" YHP's is all about.

A system that says "pay more now and less later" can actually work pretty well. But you need to be sure that "later" things will happen as promised. Enter government, as insurer, or guarantor, or regulator, or some combination thereof.

It just doesn't seem that hard to me.

Doesn't seem hard to me either, Bernie.

I'd also offer this simple proposition: no matter what system we (or The Market) devise, the "average" person has to pay his own medical costs over his lifetime.

The "average" person is a mythical beast, of course. Not a one of us pays exactly the "average" into the system; not a one of us draws exactly the "average" out of the system; not even on the scale of a lifetime. What that means, mathematically, is that some of us "win" by getting more medical care than we paid for; and some of us "lose" by being healthy all our lives.

One wonders whether conservatives, who like to "win", wouldn't be happier if we could promise them they will be sick enough someday to make a profit on their premiums:)

--TP

"Me too. Because it's the only way to make sure that everyone can get insurance."

Actually it is not the only way and it is probably not a constitutional way. You can take money from everyone, or just the "rich", or just the corporate "people", in taxes to pay for anything you can justify as the "public good". You can't make people buy something, even if it is "good for them".

You can't make people buy something, even if it is "good for them".

Car insurance comes to mind.

"Car insurance comes to mind."

Not equivalent. first it is a state law not federal and it is contingent on you wanting to drive a car. There is no corollary of using government roads or infrastructure that equates in the requirement to buy health insurance.

In many states they only require you to have coverage to cover someone you might hit, for example, not collision on your car.

Marty, you and I live in a state that DOES require us to buy HEALTH insurance. Are you okay with that?

As for the "corollary of using government roads", some fairly major roads are in fact federal highways. Would you be okay with a federal mandate to buy auto insurance?

--TP

Marty: Actually it is not the only way and it is probably not a constitutional way. You can take money from everyone, or just the "rich", or just the corporate "people", in taxes to pay for anything you can justify as the "public good".

That I should live to see a conservative and a Republican proposing the NHS model of healthcare to a pair of by-comparison-leftwingers.

Of course the NHS system is better than this system Clinton first proposed and Obama mocked her for when compaigning and has adopted now in office.

Or any of the other methods adopted by the many countries with better and less expensive healthcare.

The system Clinton and Obama proposed has one key advantage to an American politician: it keeps the health insurance companies hearty, healthy, wealthy, and happy.

TP, on the phone now so the answers are short. No I don't think that is the right way to fund it and no but I don't think it is an issue.

I am not the best person to defend the Republican position except to defend their right to have it on principle.

They certainly have every right to hold and defend whatever position they like.

Here's what strikes me, however.

When the Republicans held the White House and a majority in Congress, the byword was "elections have consequences".

Now, when they hold neither, the Republicans in Congress, and in the Senate in particular, are happy to obstruct anything they don't like.

It is, plainly, a double standard.

All's fair in love and war, and apparently in legislation and governance as well. There's nothing to prevent them from grabbing for whatever they can get, by whatever means they can get.

But given their position I think it's also fair to run them over like a steamroller if the Democrats can muster the wherewithal to do so.

The Republicans represent lots of folks whose point of view deserves to be heard.

Well, so do the Democrats.

And the Republican voice has, in fact, been heard. It's been heard, and to a far from trivial extent accommodated.

But as you note upthread, that's not enough. It's not enough to have their point of view represented; other points of view must be excluded. A bill cannot reflect their priorities and receive their support, it must reflect their priorities *and no-one elses*.

The Republican party would rather see the nation go down the tubes than for a point of view other than their own to succeed. This isn't my weird lefty point of view, they demonstrate this every day. They would prefer for nothing constructive to occur, than for something constructive to happen that they don't happen to like.

And when I say "Republican party" I do mean exactly that. I mean them as a whole, because that is how they vote.

So my personal feeling is that it would make perfect sense for the Democrats to crush them like bugs, if they could pull it off.

What are they going to say? "No fair"?

Nobody gets to have their way all the time, or in full. Anyone above the age of about 7 who isn't a spoiled brat or a bully understands that.

You're right, Marty. It's not the only way. My mistake.

It is probably the way that has the best chance, politically, in the US today.

I strongly suspect there are better systems, but am not familiar enough with specifics to advocate a particular model we should follow.

I know the French system is highly regarded in many quarters and it really would be fun to adopt it, if only because copying the French would give some folks apoplexy.

Me, I like baguettes and red wine and such. They can keep the Gauloises.

BTW, the state of Maine instituted rules forbidding coverage or rate discrimination based on pre-existing conditions, but without a mandate for healthy people to buy coverage. As noted above, the result was just what you expect: an unstable system. Initially many healthy people sign up, but *all* sick people do. The rates go up to cover the sick people, and more healthy people, who *can* do without, and can buy back in later, if they become ill, leave. Eventually, Maine's private insurance programs have come to resemble a high risk pool, with healthy people staying out of the plans.

What you guys want - real insurance that keeps paying even if you use it, can come only with widespread mandatory payments into the system. That can come with a mandate to buy private insurance, or a mandate to buy public insurance, or via significant tax subsidies.

What Maine's experience has shown, however, is that it can't come by magic.

http://healthcare.change.org/blog/view/the_pitfalls_of_forgoing_a_health_insurance_mandate_maines_experience

The Democratic fear of doing anything has got me, a supporter of Democratic candidates since McGovern's '72 campaign, essentially giving up.

It's one thing to have occasional, or even frequent, electoral setbacks -- this happens to both parties when they get too full of themselves.

But to win an election based on a specific and ambitious platform, and then refuse to exercise the tools needed to implement the platform, out of fear, is cowardice, pure and simple, and I'm no longer willing to support a party of cowards.

Obama's platform, which helped elect him and numerous others, included reinstituting the rule of law with respect to terrorist detainees, getting the economy growing again, preventing another banking crisis, ending the war in Iraq, and implementing health care reform.

He's apparently at about 0.5 for 5. The economy is growing slowly, although job growth isn't there yet. Perhaps he's banned torture, but the Obama administration still claims the right to imprison anyone, citizen or not, on the President's say so alone. The banks that gambled with tax-payer guaranteed money are still doing so, and are bigger than ever. Iraq's winding down very slowly, while Afghanistan ramps up, with no decently defined goal. Health care is a complete failiure at this point -- Congress refuses to do anything, essentially.

Yet the Democrats do nothing to implement filibuster reform in the Senate, essentially guaranteeing the Republicans a tool to stall any plans the Democrats actually get up the gumption to push.

This train wreck is like if the Allies, after winning WW II, turned over all of Europe to a defeated Germany, saying, "Well, we don't want to take responsibility for this mess you've made, anyway."

And then Sebelius and Obama can't get it quite right as to who the bad guys are. ABC notes here that the HHS report (“Insurance Companies Prosper, Families Suffer: Our Broken Health Insurance System,”) and the President accuse the insurers of huge profits, only they reference non profits in Michigan, who seem to be required to ensure everyone today.

"We're concerned about the broad brush they're using to paint the industry," Michigan Blue Cross/Blue Shield CEO Andrew Hetzel told ABC News.

"We have a regulatory system" in Michigan, he said. "We have to accept everyone."

This is not to defend any of the non-profits for the way they run their companies. Each has been criticized for premium increases, for not reducing administrative costs enough, for not being efficient or low-cost.

But they are not driven by profits, as the report and Sebelius's comments suggested.

So Maine has to ensure everyone, Michigan does, Massachusetts h as required universal healthcare, and we seem to be learning from their experience. It would be nice if the administartion noticed.

I don't know if any other state insurance commissions already require insurance companies to provide insurance to everyone but it seems the Republican proposals to have states provide solutions might actually be in motion already?

To add to my previous comment, in the same article

"Sebelius noted in her letter last week to Anthem Blue Cross in California that its parent company, WellPoint Incorporated, earned $2.7 billion in just the last quarter of 2009. Quarterly sales went from $15.1 billion to $19 billion -- a 26 percent rise."

The rise in Q4 net income was entirely because of the net income from the sale of one of their subsidiaries, NextRx, of 2.2 billion dollars. Without that sale net income was down from the previous quarter and year.

This is a level of intentional misrepresentation I might call a lie.

Still Marty,

The Insurance industry is wildly profitable - and even then, profits come after the payout of enormous, gigantic executive salaraies. And every dollar pocketed in high salary and/or dividend to shareholder is a dollar collected, but not spent on providing care to customers.

"Still Marty,

The Insurance industry is wildly profitable - and even then, profits come after the payout of enormous, gigantic executive salaraies. And every dollar pocketed in high salary and/or dividend to shareholder is a dollar collected, but not spent on providing care to customers."

None of those things are bad if health care costs dont keep going up so they have to charge more to maintain it.

I don't agree that their profits are exorbitant at 3-4% of revenue. The bonuses sound huge but they don't really touch those results. These are really big companies so the numbers sound really big, but if they were twenty little companies no one would blink at the percentages they net.

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