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August 26, 2009

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The reasons why more Americans oppose* the Democrats reform proposals than support them is much more pragmatic -- and far more problematic to Obama and the House Democrats.

No matter how many times you say it, it's still not true. Go to question #12 which reads:

"12. Would you support or oppose having the government create a new health insurance plan to compete with private health insurance plans? Do you feel that way strongly or somewhat?"

Net Favor = 52
Net Oppose = 46

Now if you want to point out that numbers have been declining or that intensity is more on the 'no' side then you'd be correct. But that's not what you're doing.

Be honest.

Health Care reform is stalled for reasons that have nothing to do with "public opposition" and everything to do with half a dozen wankers in the Senate who are enabling Republicans whose only goal is to "defeat" Obama, consequences be damned.

Seriously. Without the "moderates" in the Senate stalling and providing cover for Republican lies (see: Every word out of Michael Steel's mouth, for example), or an ounce of leadership in the Democratic "leadership", or the Senate being gone, we would already have a decent bill, with a public option. The House already passed their version months ago.

Von - let me expand on my point to be more clear. When you look at question #7 you are aggregating people who think the reform goes too far with those who don't think it goes far enough.

When you look at the specific policy recommendation in #12, you're going to get closer to narrowing down to the people who genuinely oppose reform.

No matter how many times you say it, it's still not true. Go to question #12 which reads:

"12. Would you support or oppose having the government create a new health insurance plan to compete with private health insurance plans? Do you feel that way strongly or somewhat?"

Net Favor = 52
Net Oppose = 46

Now if you want to point out that numbers have been declining or that intensity is more on the 'no' side then you'd be correct. But that's not what you're doing.

Be honest.

BFR, this has nothing to do with what I wrote.

Von - let me expand on my point to be more clear. When you look at question #7 you are aggregating people who think the reform goes too far with those who don't think it goes far enough.

Again, BFR, you're off point. Question No. 7 is not as you describe it. Question number 7 is "Overall, given what you know about them, would you say you support or oppose the proposed changes to the health care system being developed by (Congress) and (the Obama administration)? Do you feel that way strongly or somewhat?" That directly supports my point, which is about the Obama/House reform package -- not some generalized reform package.

You're trolling.

Without the "moderates" in the Senate stalling and providing cover for Republican lies (see: Every word out of Michael Steel's mouth, for example), or an ounce of leadership in the Democratic "leadership", or the Senate being gone, we would already have a decent bill, with a public option.

Nate, that's certainly possible .... although I suspect that the CBO report did far more to slow down health care reform than anything the Republicans have done.

BFR, I have re-read your comments. Although your first comment was way off point, your second comment (at 2:33 p.m., ObWi time) merits more of a response than I provided. I take back the claim that you're trolling.

I now understand your point to be that Q7 doesn't provide a reason why folks oppose the Democratic reform efforts, and that some proportion of those folks -- almost certainly a small minority, but almost certainly also not zero -- oppose the Democratic reform proposal because it doesn't go far enough. If that's your point, I agree with it.

I don't see how it disturbs anything that I've written. I also don't see how it merits your original claim that I was being untruthful.

That directly supports my point, which is about the Obama/House reform package -- not some generalized reform package."

No, that's not true. If you were die hard for single payer, how would you respond to the question?

von, I'm not talking about the Republicans. Their unwavering opposition to anything Obama or any Democrats do is a given.

I am talking about the "moderates" in the Senate who have given the Republicans the space to stall things, and prevented the Democrats from getting 60 votes to overcome the non-fillibuster of everything the Republicans are doing as a matter of course. Joe Lieberman, Ben Nelson, and Max @$!#ing Baucus, as three specifics. If Baucus had gotten the damn bill out of his committee, and the leadership actually got the Democrats to vote as a party, we would have a bill either passed or in house-senate reconcilliation by now, which would only need majorities.

That's the biggest screwup by Obama and the Democratic leadership, letting these "moderates" posture and delay and give the Republicans room to lie about it.

No, that's not true. If you were die hard for single payer, how would you respond to the question?

See my 2:44 p.m. comment, which crossed this one. Again, it doesn't matter for the purposes of my argument why folks oppose the current Obama/Democratic plans, or whether (like me) they would support some alternate reform effort: single payer, Wyden-Bennett, etc. Based on the plan that been put on stage by the Democrats, it's fair to conclude that folks will take the devil they know over the devil they don't .... even though they might really want the devil waiting in the wings.

That's the biggest screwup by Obama and the Democratic leadership, letting these "moderates" posture and delay and give the Republicans room to lie about it.

I don't think that Democrats could have passed any reform without the moderates, so I don't know that this is a screw up. I think that the Democratic leadership is largely incompetent -- a fact for which I am usually grateful -- but that doesn't mean that every wrong turn is their fault.

I don't see how it disturbs anything that I've written. I also don't see how it merits your original claim that I was being untruthful.

I don't think there's much dispute over your premise that the sales job has been lousy. That being said, the polling doesn't support your conclusion that the population opposes reform. The polling is still there for reform with a public option.

Perhaps my first comment was too harsh, but I suspected you were cherry-picking the data to find the number that most agreed with your point of view.

His premise isn't that the the public opposes reform. His premise is that the public opposes the current form of reform that the House has proposed.

His premise is that the public opposes the current form of reform that the House has proposed.

Look, that's not what the polling says. Here's what the question says again:

"Overall, given what you know about them, would you say you support or oppose the proposed changes to the health care system being developed by (Congress) and (the Obama administration)? Do you feel that way strongly or somewhat?"

If you've been surfing the left blogs, you'd have to know that a decent % of politically engaged liberals are really ticked about what's gone on in Senate finance (and assumed schemes involving Pharma & Obama).

The question doesn't call out the House bill, it's generally referencing "Congress" and the president. With that wording, you're going to pickup a lot of opposition from liberals.

many folks, all things being equal, will take the devil they know** over the devil they don't.

Um...I think we all know that - all too well.

I'd also note that a 'sales job' which is almost entirely defense - and 'existential' defense at that - is scarcely a sales job at all. 'Unlike what many prominent people have sworn over and over at high volume for months, my little productivity app will not give you hives, will not cause you to vomit blood, will not really kill your old auntie in a cruel excruciating way, nor will it enslave you and your entire country. Now...' If you have to defend yourself against oceans of nonsense which isn't even plausibly true, you are going to have a hard time getting around to the positive benefits. I have plenty of scorn for the Democrats, including Obama, for misreading instead of seizing the moment - this thing has been bungled, no doubt about it; the Democratic party itself is horribly compromised. But it raises my eyebrows when you to admit that most of the SJ has been defense, and then conclude in the next graph that Dems have done a bad SJ which isn't specific enough, etc. All this noise *has* been a distraction - but not 'mere': massive distraction is exactly what it was unleashed to cause. Mission accomplished.

Your posts on this subject do not seem dispassionate, von (nor Gerson). I think you think they do, but they really don't, at least to me. I suspect you won't convince many/any who don't already agree with you.

That being said, the polling doesn't support your conclusion that the population opposes reform.

Once again, BFR, that wasn't my position.

But it raises my eyebrows when you to admit that most of the SJ has been defense, and then conclude in the next graph that Dems have done a bad SJ which isn't specific enough, etc. All this noise *has* been a distraction - but not 'mere': massive distraction is exactly what it was unleashed to cause. Mission accomplished.

Your posts on this subject do not seem dispassionate, von (nor Gerson). I think you think they do, but they really don't, at least to me. I suspect you won't convince many/any who don't already agree with you.

Jonnybutter, I don't understand this. First, I'm not trying to be dispassionate. I'm pleased as punch that the House Democrat reforms are going no where because I do think they are worse than the current system (even as I favor reform -- namely, Wyden-Bennett). I've attacked the House Democrat plans several times, so my opposition shouldn't come as a suprise.

Second, Democrats can't blame their lack of a sales job on Republican attacks. Of course this bill was going to be attacked. The fact that it got attacked doesn't mean that Democrats are absolved from putting on a positive case.

Part of it is because they don't have a single plan to unify them. (As an aside, President Obama seemed to think that the lesson of "Hillarycare" was that the President shouldn't wade into the health care fight with his own plan. But that wasn't the lesson. The lesson was that the Clinton administration, having won with a plurality of the vote, couldn't shouldn't wade into the health care fight with its own plan .... and it definitely shoyuldn't have made Hillary Clinton the spokesperson.)

von - you should check out how that "bipartisan" reform is playing within the Utah Republican Party and Club for Growth. TNR had a post on this yesterday I think

Yeah, that doesn't surprise me, Publius. The Club for Growth's goal is to kill any reform plan; my recollection is that it also opposed McCain's proposed reforms. The fact that some Republicans do not agree with Wyden-Bennett, however, doesn't make the plan less bipartisan. Indeed, many Democrats also dislike Wyden-Bennett - one reason why Democrats aren't pushing the bill.

von: With regard to the closing comment, of your 3:20 pm, "it definitely shoyuldn't have made Hillary Clinton the spokesperson."

But isn't that the problem? Bill had been in office for a few months, but it was well known that Hillary Was Evil. If Obama had Gandhi, Mother Thersa, and every past US Surgeon General as spokespeople for health care, we would have learned from the Republicans that those people were Clearly Evil. I think that attacking the messenger is far easier than attacking the policy.

Once again, BFR, that wasn't my position.

Seems like your position is all based around the notion that health care reform is failing because Obama & House dems have done a poor job from design to sales.

The data doesn't support this - most people still prefer (by reasonably comfortable margins in fact) the core element of the House plan - the Public Option.

O.K. Let's go with Wyden-Bennett.

We'll see if Von's body-building efforts over the years enable him (and Bennett) to wrest control of the Republican Party from the scurvy, mendacious (I always pretty-up my language for Von's posts; I'm a little scared of unarmed muscle guys) lot running the show now (Limbooger, Clubfoot for Growth, Young Frankenpublicans, Yawn Inanity, Shill Oreally, Glenn Dreck, Error Eroticism (not) and Schmoe Lame over at RedDawn, Machete Steal at the RNC, Sorry Deathpalin, the minority in the Louse of Reprehensibles, Sen. Orifice Snatch of Utah, and fellow traveler Lyndon LaDouche, among many others).

Somehow I doubt Von's got the ear of the Bell Curve's lowest common denominator wannabes running the discourse now.

They're too far down the road of destruction to be turned back now. Better to ambush them at the end of that road where the rules end too and we don't need to hold back on the blood meridian justice.

Then governance can resume, if we want it any more which I'm not sure I do at this point.

People oppose health care reform for a lot of reasons, some that make sense, others that don't. Cost is a big issue. Total lack of confidence that any new and much larger federal program will be run any better than any current and smaller federal program. Fear that, as Von writes, just because things aren't so great right now doesn't mean they can't get a lot worse with a new system. I suspect that many people, consciously or otherwise, sense that the most aggressive proponents of a national system favor a statist solution to nearly every issue of the day and that a single-payer or NHS-style result is the end game, with the current iteration of reform being just a first step.

Yes, I remember Newt Gingrich and Tom Delay pointing out in 1994 that if it wasn't for Hillary Clinton leading Bill's healthcare reform effort, they would have been first in line for those commie-supplied barium enemas (and God knows there are no two people more in need of a good, taxpayer-supplied enema than those two) at HHS.

von: The whole "I support health care reform, but not this" is mildly disingenious, because if the current health care reform effort dies, the result will not be your preferred method, the result will be NOTHING, for at least a decade. If they kill this bill, will the Republicans embrace some other bill? NO. The goal is not about "better" reform, the goal is to "defeat" Obama. Will the half-dozen "moderates" who are helping kill this bill suddenly decide to support a different kind of reform? Again, obviously, NO.

So, look. You don't support the current bill, fine. But realize that that means a decade, at LEAST, of the status quo. Probably more.

As for if any reform could be passed without the "moderates", YES, it could. It did in the House. It could pass in the Senate if a) they use reconcilliation, b) the leadership had gotten on the ball and gotten the "moderates" to NOT bottle bills up in committee and/or support Republican fillibusters, or c) if the Senate wasn't institutionally broken. But it is, and a handful of grandstanding "moderates" are what's stymied the bill and enabled the Republican lies.

So it's those half dozen "moderates" you can thank for the lack of progress, and the probably death of health care reform for the next decade or two. The Republican Party is never going to support any kind of health care reform. Period.

The fact that some Republicans do not agree with Wyden-Bennett, however, doesn't make the plan less bipartisan.

The point is that zero Republicans would support it. Even ones who claim to now will bail (a comma being changed would be enough) b/c it's possible for the median GOP primary voter to accept.

Even if we went with Wyden, we'd see zero Republicans support (*maybe* Maine Senators), and certainly none pushing it.

The GOP doesn't believe in reform. period. You're ignoring the politicla realities. and if the Dems pushed W-B (which is a much more radical break with current system),they'd demagogue that.

it's not even that the GOP doesn't support reform, some of them do see the problems with the current system and acknowledge it's broken. it's that they want to defeat any Democratic attempt at reform because they want to defeat Democrats. the GOP isn't having a debate about health care reform, they're trying to defeat Obama for the sake of defeating Obama.

the GOP is a cancer.

Of course, I live in a different universe. In my country universal health care is seen as so fundamental a right that no conservative running for office would dare suggest any significant change. I am somewhat bemused by your debate and probably haven't been paying enough attention, so apologize if my questions are silly.

If reform fails this year, why a decade's wait? the problem will still be there and presumably could be the platform for 2012.

Republicans talk of a $1 trillion; yet Obama's criterion is that it be deficit neutral. Maybe there are cost overruns but surely not 100%. So the problem is that medicare recipients either do not understand medicare is a govt program now, or believe Obama is going to cut their plan to fund everything else. Why not leave everything else but pass medicare reform this year: make the cuts and changes- apply savings to deficit reduction- or medicare trust fund?


Johnny Canuck: The average time between attempts at health care reform is 19.5 years. (The rest of the article I mostly disagree with, because the public option is important, damnit.)

And because if we can't get something passed with 60 59 nominally Democratic Senators, huge margins in the House, and a Democratic President, there's no reason to expect we'll do any better with worse numbers. Like if the Democrats lose a bunch of seats by, say, NOT following through on one of their best issues. And the Republicans will be energized because "the people are on our side!" (witness von) and plenty of the people Obama inspired to come out and vote for the first time will be disgusted by the lack of change, and not show up. So NOT doing health care reform makes many of the "moderate" Democrats, especially the newbies, MORE vulnerable. Not that the Blue Dogs get that, and none of the "moderate" Senators are at risk, as far as I know.

Shorter me: Because if the Democrats blow this, they prove they're useless, and the Republicans are never going to support health care reform. So Obama won't do it, which means at least 4-8 years of not getting done, then possible Republican years (hopefully not as bad as Bush II) and then MAYBE, MAYBE another Democrat will get elected partly on a platform of reforming health care.

why a decade's wait? the problem will still be there and presumably could be the platform for 2012.

if Obama fails, given what looked a hell of a lot like a mandate on Election day, nobody will want to touch the issue for a long long long time.

"Republicans talk of a $1 trillion; yet Obama's criterion is that it be deficit neutral"

It costs 1 trillion(a minimum number). Deficit neutral means cutting some places and raising taxes elsewhere so that the 1 trillion is paid for without additional borrowing.

"Why not leave everything else but pass medicare reform this year: make the cuts and changes- apply savings to deficit reduction- or medicare trust fund?"

Great idea, but there is not enough real savings to then justify the expense of further reforms next year. The best case is Medicare reform saves a few $100B, then it will be a trillion dollars next year without the "reforms" to pay for it, because they would have been used to make Medicare solvent for longer.


"The question doesn't call out the House bill, it's generally referencing "Congress" and the president. With that wording, you're going to pickup a lot of opposition from liberals."

Which is still a majority of opposition to the current plan. I don't think anyone here is suggesting that 'the public' is against all conceivable possible health care reforms. But that isn't the same as suggesting that they would support "any" health care reform.

DFinSEA - I overstated the Hillary factor. My point is that the primary difference between Clinton and Obama was that President Obama came into office with strong approvals and a very weak Republican opposition .... Had Clinton come into office with Obama's favorables and generic D favorables, I suspect that he would have succeeded with health care reform. The lesson was that a new, weak president probably shouldn't have tackled such an ambitious program in any form -- it wasn't going to to work. It was not that the particular method chosen by Clinton was the wrong method for any new President (Obama's apparently conclusion).

I hope Thullen's ambush doesn't occur on a day when I'm supposed to walk point.

I agree with McKinneyinTexasM's points. And, again, there would be less fear or opportunity for misinterpretation (intentional or otherwise) if there was an actual Obamacare plan to defend, rather than endless back-room negotiations.

Publius, we'll likely never get a chance to test your hypothesis that Republicans will pull a Lucy if Wyden-Bennett ever gets traction. That's because Democrats refuse to bring Wyden-Bennett to the floor, preferring a costlier and worse alternative, primarily due to pressure from Big Labor (which opposes Wyden-Bennett).

However, even if you're right that the Republicans who say they support Wyden-Bennett are all lying, you can't blame the Republicans for not presenting Wyden-Bennett. Sole blame for that falls on the Democrats, who have the Presidency as well as huge majorities in the House and Senate.

Nate, the consequences of the Democrats passing a controversial health care bill that lacks the clear support of the public without any Republican support may well mean the end of the Democratic party, will be a Republican majority in 2012. That's because no plan will result in a noticeable improvement in anyone's health care coverage .... indeed, change will likely itself create headaches in at least the short term.

And, yes, I am fine with the status quo if the alternative is a plan that will cost 1 trillion, increase the deficit, and not accomplishing its primary aims. We can, and should, do better.

In my country universal health care is seen as so fundamental a right that no conservative running for office would dare suggest any significant change.

That can't be the entire case, Johnny Canuck. Didn't the President of the Canadian Medical Associate recently say that “We all agree the system is imploding, we all agree that things are more precarious than perhaps Canadians realize”, and suggest the need for private insurance? (I don't mean to suggest that the CMA necessarily opposes the concept of universal health care; only that Canada may not be a particularly good model.)

"Republicans talk of a $1 trillion; yet Obama's criterion is that it be deficit neutral"

It costs 1 trillion(a minimum number). Deficit neutral means cutting some places and raising taxes elsewhere so that the 1 trillion is paid for without additional borrowing.

It's worth noting that the House Democrats plan is not even deficit neutral.

von: "the consequences of the Democrats passing a controversial health care bill that lacks the clear support of the public without any Republican support may well mean the end of the Democratic party, will be a Republican majority in 2012."

Funny, since that's the likely consequences of NOT passing a reform bill. But hey, Everything is Good News for Republicans!

That's because no plan will result in a noticeable improvement in anyone's health care coverage .... indeed, change will likely itself create headaches in at least the short term.

The first half of this statement is false, and the second half is a reason to get it done sooner, so the short-term change headaches are over by the next election, and the benefits are more visibile

von: The Republican Party Does NOT support health care reform. Of any sort. The "support" of W-B by Republicans is given lie by many of its "supporters" in Congress who have said they'd vote against it if it was up. And W-B is NOT the alternative here. The alternative is another decade + of the status quo, which you find acceptable. So why don't you simply say "I support the status quo", because the options are not the current bill and your favored plan, the options are the current bill and NOTHING, but a nothing that might bring Republicans back to power, with the lesson that completely insane lies and obstructing everything are the way to win.

If the current reform bill goes down, it won't be the "moderate" Republicans taking credit. It'll be Rush Limbaugh, Glenn Beck, Sarah Palin, and that ilk. It won't be the legendary "reasonable Republicans". And then you might find yourself upset about how crazy your party is again, so you vote for the next moderate charismatic Democrat that comes along, and act surprised when that doesn't result in the crazy Republicans stopping their craziness.

I don't think anyone here is suggesting that 'the public' is against all conceivable possible health care reforms.

Von is using the results of a poorly phrased question to conclude that the current reform plan is opposed by the majority of the public. Then he goes on to explain why the plan is failing.

There's always going to be a significant amount of opposition (approaching or exceeding 50%) to any health reform plan. If you lump those who think the approach is too aggressive with those who think it's not aggressive enough, then your conclusions/recommendations are going to be all wrong.

Von is right. The Democrats are losing because the Democrats and Obama screwed up. Obama apparently thought that he could win by giving the country a constitutional law type lecture about health care and letting Congress lead. Well, its isn't freaking working. Congress has produced ont one but three big bills-each as c onfusing as anything Hillary put out.
The Republicans have demagogued the bills as relentlessdly as anything, and have pretty much ignored any calls to bipartisanship. The word itself has pretty much become a sick joke, as one Republican after another has admitted that killing the bill is job one. With all the talk of "death panels" and "socialism", it looks like even the moderate Congressional reform bills will fail.

What have we learned? Well, its time for Obama to take off his " law professor' cap and put on his "give em hell" hat. Its time to get in there and mix it.

Whenever someone complains to me about how the President needed to get out and play offense on this thing, I think about an entire campaign season where he campaigned heavily on how important this was. I also think about him holding regular pressers about it over the last few months and the MSM complaining about how it hurt their bottom line. I then remember his last presser in which he (yet again) made the moral case for reform, (yet again) knocked down the newest round of Republican lies, and (yet again) explained the need for some of the more controversial items in these plans. And as I recall that the ONLY "MAJOR" STORY REPORTED OUT OF THE PRESSER was a non sequitur question near the end and that the minor stories included several about how Obama just new the details of health care too well, I think to myself that the story about how shoddy the pitch has been is BS. Political discourse in this country sucks beyond belief and there is no reason to believe that the Dems were ever going to effectively carry a message through the media that was even mildly substantive.

Von, what percentage of the population do you think would support a bill along the lines of Wyden-Bennett?

And I think I asked in an earlier post, but hwere on earth on getting this union stuff. again, W-B would demagogued from on high by everyone, esp republicans.

"...the public option is important, damnit." -- Nate (5:57 PM)

Um, why?

I mean, I can see the argument that something needs to change. I can see the argument that the public option might be an improvement (whether or not it would be the best way to go). But the position you are taking sounds distinctly like the union head who refused to compromise on the subject when the issue of the health care system was almost resolved . . . in the early 1970!

Yeah, No Compromise. Really worked out well that time, didn't it?

So why is a public option so important, that it's worth taking the chance of putting off health care reform for another quarter century? I just don't see it, but perhaps someone can explain.

The public option is important because it's one of the cheapest ways to expand coverage in a manner that doesn't feed the inflationary beast of healthcare (like subsidies) or push the cost burden onto businesses (like the employer mandate) and individuals (like the individual mandate).

Anyone that seeks universal coverage and rules out the public option is far from pragmatic. You can eventually get rid of a public option once healthcare costs are under control but trying to build a universal system without it is an uphill fight. Or in short, there is potential for the public option to become obsolete (or become all-encompassing). But that's when the conversation about whether or not to have a public option remotely makes sense. Not now.

von: The Republican Party Does NOT support health care reform. Of any sort. The "support" of W-B by Republicans is given lie by many of its "supporters" in Congress who have said they'd vote against it if it was up.

Again, that is a hypothesis that we will never be able to test (it seems) because the Democrats refuse to consider W-B. Not because W-B is inferior: most Democrats will go out of the way to praise W-B as superior. No, Democrats are killing W-B because, among other things, certain powerful unions have negotiated health care plans that, before they bankrupt the companies in question, are much better than the average health care plan.

Again, you and <>Publius can argue that Republicans killed W-B through -- what? Sneakiness One ad from the Club for Growth? But the facts remain. Democrats have a majority in the House, a majority in the Senate, and the White House. Obama followed one of the least popular Republican presidents in history. The fact that W-B isn't being considered -- and hasn't been considered, long before the Club for Growth got involved -- is because the Democrats will not bring it up. And that's frankly dispicable: politics at its narrowest and worst.

Von, what percentage of the population do you think would support a bill along the lines of Wyden-Bennett?

I don't know: no one really knows about Wyden-Bennett except wonky types, who love it ... just not enough to push it hard.

We do know, however, that a large percentage of the population favors health care reform. We also know that a large, and growing, segment of the population thinks that the House Democrats and Obama's approach to reform is wrong. Given that the current House plan seem poised to go down in defeat (will surely be spun as merely advancing in a different direction by its proponents), I'd venture W-B can't do much worse. I think it's possible that a good sales job for Wyden-Bennett would get it done.

As for the topic, I somewhat agree with Von. The Democrats are playing defense. I disagree that they Wyden Bennett bill is an easier sell. With the W-B bill, you really ARE changing everyone's coverage. With the democrat proposals you at least get to expose republican lies for what they are when the bill passes. But you can still get hit while you are going on offense. What is the sales job for W-B? You get to lose your coverage and buy it on an individual market that currently sucks ass but is promised to be much better?

The main problem is WHY the dems are playing defense. And i strongly believe that's because they are considering endorsing whatever comes out of finance (if anything ever does) and that's going to be very different from what the house has put out.

"Given that the current House plan seem poised to go down in defeat. . ."

This seems like far from a given to me.

about 85% of Americans [think they] have health insurance or coverage under the current system.

Fixed that for you. You do know about the rescission problem? The one that preferentially affects people who turn out to have something expensive wrong with them?

You expect voters to suddenly become altruists, and vote en mass against their self interest?

There are an awful lot of non-wealthy Republican voters in the US who routinely vote en masse against their self-interest. So, yeah: if politicians lie hard enough, they can get voters to vote to keep themselves worse off.

Having read a brief overview of W-B, von, I have a question:

Does any other country do this?

I personally have had *enough* of American exceptionalism and insisting on being the first penguin off the ice floe. There's no point in having a big world if you have to keep inventing the wheel to prove how Special we are.

I also am quite appalled at the idea that the solution to our problem is to give more money to insurance companies. Step right this way for yet more regulatory capture and market failure!

I will also add that the reason I am for single payer is that I abhor means testing. To people of means, means testing may seem "only fair", but in practice it is tiring, degrading, confusing, privacy-destroying, and taxing in every sense. It also inevitably involves huge, invasive bureaucracies and the pushing of much paper, things to which von is deeply opposed.

Von @ 7:35 - "We also know that a large, and growing, segment of the population thinks that the House Democrats and Obama's approach to reform is wrong. "

No, we don't. We know that a major media press to frighten voters with insane untruths is working, just like The Big Lie always does, and that those voters are worried and afraid. Trying to mound it up into some kind of actual opinion is disingenuous, and unsupported by the evidence. Your conclusion there is uncalled-for.

I confess you have made Wyden-Bennett sound quite interesting; however, I agree that it is a bigger break from the status quo than a public insurance option - and by rights should be a tougher sell thereby. Your argument goes off the rail when you suggest otherwise.

Also on the disingenuous list is your (conclusion? suggestion? assertion?) that Republicans would support W-B. If you haven't been listening to conservatives, Republicans, etc recently, then you should be aware that after arguing *FOR* co-ops versus the public option, there came a moment when it looked like said option was cooked...and the Republicans began almost as one to attack co-ops in basically the same unhinged, reality-free "logic" they used with the public option.

If you really believe that the Republicans/"conservatives" would support a better option - *any* option - in an Obama administration, well...you should listen to them.

They're telling you otherwise.

Always appreciate your posts.

Doctor Science asks the most relevant question, in Does any other country do this? The US has had sixty years to develop any viable alternative to a system in which the state is fundamental guarantor of health care and has utterly failed at it, producing instead a hodge-podge in which the fraction of the public that can count on care when they need it shrinks while windfalls to insurers, pharmaceutical manufacturers, and other corporate blocs rise.

Wyden-Bennett seems resemble some parts of the German system, but with this crucial difference: we know, thanks to their own public testimony, just how committed our major insurers are to providing the least possible care at the greatest possible return to themselves. I don't see why we should be trusting any major existing insurer in the sort of system W-B proposes, nor any evaluation of the cost of starting up a whole new insurance market without them. But I think that allowing the major players in actually existing American insurance to be part of such a setup would be exactly, precisely, the same sort of mistake as letting people like Cheney and Rumseld set foreign policy.

Also, the German model strikes me as a poor one because we do have a suitable alternative in place: Medicare. Bismarckian Germany didn't, and Bismarck's approach was a sound sensible one given the situation of 1890s Prussian Germany. But since we have Medicare, it seems to me very foolish indeed not to build on it.

I don't actually think that Wyden-Bennett is a bigger break from existing practice than some of the alternative, or at least it doesn't feel like a break in any good direction since it puts insurance companies at the center of things gain. I think that American insurance as an industry has decisively proven itself untrustworthy, so I propose to let them go join the buggy-whip manufacturers.

Chmood: Yes, all this pundit "enthusiasm" for Wyden-Bennett is a smoke screen. They talk it up because it's not an active possibility. If it were to become one, they'd drop it in favor of something else that won't get done.

I can understand why conservatives (real conservatives) maintain a healthy distrust of government: however, replacing it with uncritical fawning over powerful and entrenched for-profit industries that will screw everyone for an extra nickel apiece (a glance at the record demonstrates this, and nowhere more plainly than insurance).

Seems that for some, private-enterprise slavery is better than government-supported liberty...but they REALLY need to sort out their vocbulary.

Ooops: umm, "...replacing trust in government...."

FWIW, I own von a bit of an apology. I commented and ran earlier - busy day. I partially misunderstood his post. My bad. I hope I have time to read the rest of the thread before too much time passes...

The reasons why more Americans oppose* the Democrats' reform proposals than support them is much more pragmatic

Read Nate Silver.

What generally appears to be happening is that asking a question about "the President's plan" or "the plan in Congress", without going into any details, gets you limited support, or slim majorities opposed.

However, when the plan is accurately described in the poll question, the support is reasonably strong --on the order of 60%.

So Americans DON'T oppose the Democrats' reform proposals. They like the public option. They like exchanges. They only oppose whatever mythical monster they've been led to believe is being considered in Congress.

Clearly this discrepancy isn't ALL due to "death panel" disinformation--proponents deserve some criticism for a poor sales pitch and the general public deserves some criticism for its general ignorance--but it's also clear the slurs have done some real damage. You can't dismiss their effect.

The folks who believe these kinds of rumors are not going to support any Democratic-led health care reform effort.

Just to elaborate, the difference between 60% for, and only 48% for is not the people who really believe these rumors. But the rumors are very effective FUD, they don't have to be fully accepted to be effective, they just boost people's disengagement and natural tendency to be skeptical of Congress.

That 12% discrepancy are the people who answer, "Oh dear. Well, I don't really know what's going on with this whole health care business. You don't know what to believe anymore. But that plan they have in Congress sounds like it has so many problems. I guess I am opposed to it."

A good bulk of the opposition is made up of old people. Let's get that straight first of all. For the rest of us that aren't deathly afraid the government will get between us and the communist paradise that is social security and medicare, i think it's fair to say that rumor and uncertainty play a significant role in the decision making of those opposing healthcare.

Again, that is a hypothesis that we will never be able to test

I think this refrain is a bit silly. This is a blog, not a court of law or a science experiment. We may never be able to "test" the intentions of these supposed W-B supporting Republicans, but, really, we weren't born yesterday. We can make inferences. If you believe there would actually be more than 1 or 2 Republican votes for W-B if it came up, I've got a bridge to sell you...

(it seems) because the Democrats refuse to consider W-B. Not because W-B is inferior: most Democrats will go out of the way to praise W-B as superior. No, Democrats are killing W-B because, among other things, certain powerful unions have negotiated health care plans that, before they bankrupt the companies in question, are much better than the average health care plan.

There might be some truth to this, but I'm not sure it's dastardly as you make it sound. The fact is that it's not "powerful unions" that congress is worried about, it's all the workers (read: voters and activists) who make up the unions and make them "powerful" in the first place.

After all, the leadership of most national unions would really be perfectly happy with just about ANY halfway decent health care reform. As long as it relieves the pressure of health care at the bargaining table (remember: health care costs put pressure on wages, double for gold plated plans). But it would be very hard for them to get their membership to get behind any plan that rearranged things too much and created a lot of uncertainty about their benefits.

And that goes for the general public too. W-B is a just a more "risky" play. More novel, more scary, and probably even easier to demagogue.

The fact that W-B isn't being considered -- and hasn't been considered, long before the Club for Growth got involved -- is because the Democrats will not bring it up. And that's frankly dispicable: politics at its narrowest and worst.

See the above. Aiming for something that is politically possible rather than impossible is...well, politics. But politics at it's "narrowest and worst"? Really? I think I'd save that kind of language for the death panel crowd. And all of the congressional Republicans who want to kill health care reform--and consign millions of Americans to bankruptcy, suffering, and premature death--in order to score a passing political blow.

A good bulk of the opposition is made up of old people.

Posted by: Derek | August 26, 2009 at 11:31 PM

Apparently, that’s most Americans….or at least the Americans that matter.

And, I suspect most of those old folks are white. I haven’t heard many non-white old folks engage in the paranoia and lies.

certain powerful unions have negotiated health care plans that, before they bankrupt the companies in question, are much better than the average health care plan.

This is also a bit of cheap class warfare.

It's not as if the "much better than average" plans that some (by no means all!) union workers have are somehow too good for "average Americans" or something.

In fact, as health insurance plans go, "much better than average" probably just barely pushes you into "adequate" territory these days. ALL Americans should have health care like that. Or better.

And we obviously can. Easily. Every other industrialized nation does. But we certainly can't in the current structure. (And the unions know this. Which is why they want to get a handle on health care cost growth. Which sorta explains why unions with such great health insurance still want reform.)

I've been reading the analysis and comments on this part of the page with great interest. Overall, the Dems have not helped their cause by churning out what are three separate bills, the content of which overlap with each other in some respects but differ just enough to reveal the divides among the rank and file. I have not read the content of either Wyden-Bennett or the other bills (which I now really want to), but it seems that features of each of these, put together, would make for a helluva great bill that would be compelling enough to work out the dollars with.

More fundamentally, as I've pointed out before, I think the main problem with the Dems, and why they might still have this division plaguing them, is a lack of nerve. The right has no problem being strident and cocksure, and while it makes them look ridiculous, you have to admit that they have a certainty about the positions they take that accounts for how they get people to buy into their line - even where it is corny or parochial, or reveals them to be greater know-nothings and jackasses than what we thought they were, or at worst, squinty-eyed, racist, and sympathetic to fascism. I'm NOT defending them on any of this - I'm saying that their confidence buoys them on things that no-one without his ass hanging out his pants would be caught dead on.

Exactly what is it about the Dems that prevents them from offering a robust platform for their policies that can withstand the battering it is expected to take from dolts? Has the left been too constipated for too long with identity politics and such? So much of what the right routinely has been getting away with would get you kicked out of a junior high school debate, which of course, begs the point to be made - they haven't shown that they're terribly interested in debate, so stop trying to make them debate it.

What exactly is it that paralyzes the Dems? The arguments here against the Dems taking up way too much time defending themselves in these proposals don't seem terribly convincing against the arguments that show that indeed, they have been more on the defensive than the offensive; and I happen to believe (as I've also said here before) that Obama, and the Dems all they way down who support the most robust aspects of the various bills in question and any of the reforms they entail, need to stop being so meek on this and take the gloves off. It works for the right, and they don't apologize for it. The Dems don't have to get into mudslinging and personal attacks on people; what they need to do is to stop alternately proposing all this, then acting as though they have something to apologize for. It sends the message that they indeed aren't sure of themselves, and the right will make one helluva roast beef and baloney sandwich out of this every time out.

von:

This is something that still puzzles me. You first start off by saying that the reason health care reform is failing is because people prefer the devil they know over the devil they don't. (A point with which I largely agree.) But then you throw all of your support behind Wyden-Bennett, a bill that deviates much more dramatically from "the devil you know" than the bill currently before Congress. And this is supposed to have an easier time passing how, exactly?

I know we've been through this before, but if B.S. like death panels and pulling the plug on granny and complete government takeover is getting traction, imagine what happens when you tell people (truthfully) that they're going to lose their pre-tax, employer-provided health benefits, and that they're totally on their own in finding insurance. You really expect Joe Sixpack to think that's an improvement over the current proposals?

You're right that wonks love Wyden-Bennett, but as far as I can tell, they're the only ones who do.

Finally, who does a guy have to beg around here to get a "subscribe to comments" feature enabled?

Has the left been too constipated for too long with identity politics and such?

Which nation are you talking about? This nation has been built by identity politics. The Right seems to realize this, much better than the Democratic Party.

Perhaps I'm confusing things by using the "Democratic Party" and "the left" interchangeably, when in the strictest sense they aren't.

I'm talking about identity politics in relatively recent terms - the idea of a narrowed, yet deep conception of identity as the locus of all political deliberation and action that seems to have overtaken the left, away from pragmatic positions about income and social inequality, unemployment, and such.

There was a time when the Dems had no problem with offering a robust platform for their policies and beliefs, and the left (which in this case, I mean an intellectual and academic cadre of writers, critics, researchers, other assorted experts and such, some of whom went into politics themselves) had no problem endorsing and even fighting for them. In that sense they were comrades-in-arms. But a different, post-modern (a term I dislike, but for lack of another, there we are) left emerged after the Sixties: one that wouldn't touch pragmatic, legislative politics with a ten-foot pole and immersed itself in language games, political correctness and such - so much of which seems to have suffused the vocabulary of identity politics in the sense I meant here.

What I needed to imply was, after the fact, how a sense of distance from the fray also overtook the Dems around the same time, but which really became marked in the advent of Reaganism: the idea that liberalism had become such a dirty word that liberals themselves couldn't utter it, and that so many of the core beliefs that marked it couldn't be fought for vigorously. But what I also needed to imply was how a correlative timidity that came about still seems to be lurking in the collective psyche: the idea that the Dems still have to play by some code of honor, that they still have to be civil with people who are demonstrably uncivil, even anti-civil, especially in the whole health care reform issue. For many liberals, the health care fight is something they feel they can get to be openly passionate about, but that their party is still not fighting effectively for given how the right is scoring points off it in ways they shouldn't be able to.

I suppose the remark about identity politics was an unfortunate attempt to make it into a straw man that didn't add anything to what I meant, and I would have been better off not blurring/confusing Dems and the left with this term. My apologies on this.

Posted by: wj:

"So why is a public option so important, that it's worth taking the chance of putting off health care reform for another quarter century? I just don't see it, but perhaps someone can explain."

Quite simply: because without it, we don't HAVE ANY health-care reform. What we have is "The Insurance Industry Preservation Act" under another name (and cover story).


( "THREE WEEKS!!?! But the sign says "One-Hour Cleaning"!" )
("Sorry, sir - that's just the name of the shop" )


Here is a link. Maybe this is why some of us disagree that the time for talking is over and that even a bad bill is better than no bill at all:

http://www.telegraph.co.uk/health/healthnews/6092658/Cruel-and-neglectful-care-of-one-million-NHS-patients-exposed.html

McKinney, how is UK experience relevant? No one is proposing govt takeover of health care, at most the option of govt insurance to compete against private insurance.

"A good bulk of the opposition is made up of old people. Let's get that straight first of all. For the rest of us that aren't deathly afraid the government will get between us and the communist paradise that is social security and medicare, i think it's fair to say that rumor and uncertainty play a significant role in the decision making of those opposing healthcare."

I have to say this is a pretty internally inconsistent argument. Is it bad that ss and medicare is a Communist paradise, or good? If so should we be trying to duplicate the effects of it for everyone else? Do the old people not deserve the benfits that they paid for out of their paychecks for their whole lives?

(These are entitlement programs but the vast majority of people ,and their employers, receiving these benefits paid their 15% of income to fund them).

I just don't understand it.

For many liberals, the health care fight is something they feel they can get to be openly passionate about, but that their party is still not fighting effectively for...

The Democratic Party is a partially 'captured agency' (not a perfect expression, but you get the idea). I think liberals who haven't done must face that fact. That doesn't mean that the whole thing is a sham or that there's no difference between the two parties - hardly. But the dems are quite compromised, and it very much remains to be seen if the Obama years will see a change in that situation.

The NHS is probably the worst example of foreign systems, and yet it appears to provide roughly similar results to our system at ~40% of the cost. I don't want the NHS either, but damn, this is ridiculous.

Wyden-Bennett, bits of which I like, tears down the current system (part of the reason I like it!) which makes it a harder sell! One of the scare tactics I've seen is the claim that the Dem proposal will result in people being "forced" out of their current insurance and into the public insurance option. This appears to have traction, at least with conservatives. Ok then, imagine having a bill that honestly killed employer-based healthcare entirely? That means, what, half the population or more have to go out and find new insurance? They'll freak.

Chmood: I couldn't agree more, though I can see the valid arguments governing the terms under which the public option would be carried out and the difficulties therein. But I'm with you in that the concept of a public option needs to be there because the insurance industry clearly can't be counted on to regulate itself, and throwing, say, tax breaks at them to play fair and nicey and stop doing their unfair and nasty habits wouldn't seem to re-route them from their drive in maximizing profit as their raison d'etre.

Short of a public option, a friend of mine I've discussed this with suggested that the only thing left would be for someone to take an insurance company to court for any one of a number of typical practices (for example, unreasonably high co-pays, clauses excluding pre-existing conditions, etc.). If it's ever been done, then someone post here if they know so because I'm not aware that it has. He didn't know either - and I told him that my hunch that the reason this probably hasn't happened is because a) the ideal plaintiff would be someone in the least position to do so - a patient or family of a patient, who already is so far in the hole financially that legal action is impossible, and that b) because I'm almost certain that even if there were such a case that went all the way, in favor of a plaintiff, the commerce clause of the Constitution would come up and any ruling against an insuror struck down (say, on the basis that such a ruling would entail an unreasonable restriction of commercial activity) by the Supreme Court. (Note - I'm no legal expert, so all this is only my educated guess. No further legal redress would then be possible, and the private insurance juggernaut would swathe merrily on its way.

This is a corollary way of saying that the little guy really is stuck between a rock and a hard place, and since it's up to Congress, a public option has to be there not merely out of altruism but of necessity.

Obama, and the Dems all they way down who support the most robust aspects of the various bills in question and any of the reforms they entail, need to stop being so meek on this and take the gloves off

but they won't.

the Dems just don't have the strong party unity or message discipline of the GOP. they're a bunch of free agents, loosely associated. and when they take the gloves off, they often end up punching each other.

Will Rogers' famous quote is still applicable today: I don't belong to an organized political party; I'm a Democrat.

and it doesn't help that the media can't get enough of GOP chatterers on their talk shows, or that actual liberals (as opposed to left-leaning moderates) are as rare as hens teeth in the media.

but the reason the Dems are on defense here (and in most other areas) is pretty simple: the media is afraid to call a lie a lie. the GOP knows this and is perfectly willing to lie about the Dems' positions right out of the gate. their fist is to saturate the airspace with nonsense. and by the time the discussion reaches the kitchen table, the GOP lies dominate it, and the Dems are forced to play defense for weeks and weeks while the media slowly realizes that some of the things "people" are saying aren't perfectly accurate. then we get little fact-check pieces on NPR that point out that some of these GOP talking points are somewhat misleading! but it's too late.

"...their fist is to saturate..."

should be

"...their first move is to saturate..."

McKinney, how is UK experience relevant? No one is proposing govt takeover of health care, at most the option of govt insurance to compete against private insurance.

And I'd add that I would find these sorts of "well something bad happened in the NHS" type arguments pretty unconvincing even if a socialized system were on the table.

One, the idea that this means we should wait and do nothing makes the assumption that nothing equally disgraceful (but possibly different in the particulars) ever happens in the US system. I find that pretty difficult to buy - not without some solid evidence anyway. The failures are just more diffuse and difficult to pay attention to.

Two, like everything else, the NHS will always have its warts. But at least with a public system there's recourse when problems emerge. People get mad, parliament listens. Things get fixed. Or at least patched up pretty well.

Contrast this with our own wonderful system of quasi-monopolist private insurers and innumerable uncorrected market failures, protected by a byzantine web of regulations and armies of lobbyists. And things don't get fixed. Not without a World War III-style brawl like we're having now, anway.

Without trying to rub what already have been several long-assed posts on my part into the dirt, here's something from just the other day that I overlooked - from Mickey Kaus' Slate blog:

"Public Option": The Centrist Alternative to Government Control?

which is chock-full of goodies about a SCOTUS-range plausibility of health-care rights, within which it links to Jon Alter's Newsweek web-based piece on health care as a civil right.

I post these because it had occurred to me that I couldn't be the only one who had thought of a legalistic, rights-based angle about the health-care debate (and one more time, if it occurred to anyone else who has the legal background/poop for this, please post and happily show up any ignorance on my part).

Yes, but in context ---

"....... their fist is to saturate the airspace with nonsense, ........."

--- makes perfect sense.

What is our fist?

Why don't we make a fist?

And lacking a fist, why not opt for the swift kick in the gonads, the ear bite, the eye gouge?

Say a guy (let's say subhuman Republican debris, Neil Boortz, not to be confused with the fine human Republicans who accidentally, but too late, find their Party terminally infested with the aforementioned subhuman debris) walks up to you in a bar and apropos of nothing, accuses you of murdering his grandmother and tells the assembled dumbass drunks (who rise off their barstools in a threatening manner) that you were the guy who got Hitler and Stalin together at the beginning of World War II for the final healthcare plan.

What's your first move? Patient explanation?

Say he's got an NRA vibrator strapped to his leg. What, are you going to wait until he attempts to pleasure you, or are you going to drop the guy first?

"If you believe there would actually be more than 1 or 2 Republican votes for W-B if it came up, I've got a bridge to sell you..."

I don't understand this argument. Let me see if I'm getting all of it.

1. Republicans are going to viciously oppose any reform.

2. No reform is going to get more than one or two of them.

3. Republicans are going to lie about any reform.

THEREFORE

Democrats can't choose a plan (Wyden-Bennett) that nearly all experts think is better than the currently proposed plan(s).

I just don't understand how the THERFORE works in that argument.

Why is NHS relevant? Because it is an example of what a nationalized system can become. If today's US system is bad, don't think it can't become worse. Right now, no one knows what 'reform' would look like, but many 'reform' proponents desire something more akin to Canada's or the UK's system. Both are terribly flawed and neither offers a viable alternative to the average citizen.

The 'public option' is likely a potential disaster. The private sector cannot compete in the short term with a government subsidized entity that offers the appearance of similar services at below market costs. Long-term, the public option cannot but help to morph into a single-payer/nationally exclusive entity at which time market forces will become a factor--the best and brightest will leave medicine because it doesn't pay well enough to make the effort worthwhile, leaving behind the medical equivalent of what we have today in public education: considerable levels of mediocrity guarded by layers of institutional protection.

Rob in CT: The NHS is probably the worst example of foreign systems, and yet it appears to provide roughly similar results to our system at ~40% of the cost.

Better results. Brits live longer, healthier lives than Americans do. Of course it helps that in the NHS, a man who had suffered a brain injury that left him unable to eat or drink without help, would not be dependent on his wife begging for money from his neighbors to help pay for nursing home care. link

The stats the Telegraph quotes are appalling: one million NHS patients complaining of neglect and abuse. The NHS sees one million patients every three days. I think it's appalling that 0.82% of NHS patients suffer from neglect and abuse: it ought to be zero. But it's our health service, and grumbling about it is our privilege.

But we don't leave patients to starve for lack of health insurance: we don't let children die at 12 of tooth abscesses: and our A&E rooms are used for emergencies only. (I queued for 20 minutes last time I went to one: because I'd fallen badly on my wrist on Friday night, and wanted to check with a doctor on Saturday that it was just badly bruised, not broken.)

We live longer, better, healthier, and happier lives than you do thanks to the NHS: I can see why you won't be allowed to have the same level of healthcare - socialistic takeovers! - but you could at least understand that this is something much better than what you've got, that you are being denied because it does not suit your corporate overlords that you should have it.

Again, it doesn't matter for the purposes of my argument why folks oppose the current Obama/Democratic plans.... Based on the plan that been put on stage by the Democrats, it's fair to conclude that folks will take the devil they know over the devil they don't ....

I just don't see the logic. If someone objects to the Obama plan because it does not go far enough, we cannont conclude that they prefer the status quo.

In fact, the first part of the quote seems to directly contradict the second- it doesn't matter why people object, ergo they are objecting because they prefer the status quo. Unless you are confusing 'I do not support the current plan' with 'I prefer the status quo to the current plan', but that is clearly not what the question asks.

Your position appears to be that people don't support the proposed reforms because they already have health insurance and don't want the uncertainty of change. Yet, a majority of them prefer some kind of public option- how does that fit with people voting selfishly because they've already got insurance?

Nate, the consequences of the Democrats passing a controversial health care bill that lacks the clear support of the public without any Republican support may well mean the end of the Democratic party, will be a Republican majority in 2012.

I think if the GOP opposes reforms, and they work, they'll be in the desert for a generation. But you miss the critical factor- if the reforms work, the Dems get the credit, if it doesn't they get the blame. Whether the reforms were "controversial" and "lacked clear support" in 2009 won't matter a lick in 2012 I suspect.

The private sector cannot compete in the short term with a government subsidized entity that offers the appearance of similar services at below market costs. Long-term, the public option cannot but help to morph into a single-payer/nationally exclusive entity ...

prove it. show your work.

your theory should also be able to explain why what you say is inevitable hasn't happened in the Netherlands.

Pity that no one seems to want to provide an answer -- most of all the Democrats.

Sometimes, you seem to go overboard with the partisanship. Dems won't bring up a bill that the GOP is sure to demogogue, must be the Dem's fault. There are tough questions out there that aren't being answered- by Democrats. GOP Senators etc telling lies about death panels aren't the problem, it's the Dems fault for not controlling the messaging. After all, the GOP was always going to attack reform efforts with a pack of lies, we can't *blame* the GOP for that. Really, that's the Dems fault too, if they hadn't proposed reforms the GOP would never have had to lie about them.

Democrats can't choose a plan (Wyden-Bennett) that nearly all experts think is better than the currently proposed plan(s).

I just don't understand how the THERFORE works in that argument.

That's because you're carefully trimming away and ignoring the rest of the political and policy landscape.

- W-B would be a much harder sell to EVERYONE, Democrats and Republicans alike, because it's so much more disruptive. It'd probably be that much easier to spread FUD about too. Heck, some of the current FUD would even be halfway true if said of W-B.

- If anything I think your argument there would seem to favor some kind of single payer plan: if Republicans really can't be counted on, why not go the full monty. You'd get a lot more liberals on board (believe it or not, even some state labor groups are not on board with the Obama plan, and refuse to support anything but S-P), plus more enthusiastic support from those on the liberal side who are only offering tepid support now.

No objections from me. Frankly I think that might well have been just as effective a course politically, and probably at least as good from the wonk side too. But Wyden-Bennett it isn't.

And at least the current proposal has something of a sop to the single-payer crowd with the "public option". Wyden-Bennett is just the worst of all worlds. Hard to sell to liberals, Republicans still wouldn't even be buying, plus likely a lot easier to demagogue. It's a nice intellectual novelty for wonks to play with, but at the end of the day it's unlikely to actually be be cheaper or more effective than more proven single payer or NHS-style systems. So what's not to love?

The private sector cannot compete in the short term with a government subsidized entity that offers the appearance of similar services at below market costs.

I'm sure you'll be glad to learn then that the currect plan has no such government subsidized entity. The much discussed "public option" is not subsidized, it's funded through premiums, just like all the private plans in the exchange.

(There will be voucher-like low income subsidies, but those are used to pay premiums, and can be used for public or private plans equally.)

Long-term, the public option cannot but help to morph into a single-payer/nationally exclusive entity at which time market forces will become a factor--the best and brightest will leave medicine because it doesn't pay well enough to make the effort

Sure. Just like all the other industrialized countries with public/private health insurance exchanges (that somehow haven't morphed into single payer yet...), or single payer or socialized systems, where all the doctors are forced into the profession by jackbooted government thugs, and the quality of care is so miserable, it's barely better than the US...

Oh. Wait.

'The "public option" is likely a potential disaster.'

I always expect this to be followed up by stories of utter failure by the gummint healthcare option. But, it turns out that the public gummint option is going to be a rousing success -- read "utter failure".

"the best and brightest will leave medicene because it doesn't pay well enough to make the effort worthwhile."

Do you what happened in Canada, the U.K., the Netherlands, Australia, and France? Two weeks after universal health services were instituted, all of the doctors quit and became dogwalkers, waiters, high school guideance counselors, and trashmen.

In America, doctors take the Hypocritical Oath rather than the Hippocratic Oath, so I expect they'llall become quant bond geniuses and move on to screw up the banking system again in a few years.

http://www.nytimes.com/2009/08/27/opinion/27kristof.html?_r=1&ref=opinion
'Health Care Fit for Animals' by Nicholas Kristof
Is this where we are going? Pap smears in the pigsty? It's the reality for tens of thousands of Americans. The opposition to health care reform doesn't seem to let RAM bother them. It bothers me, a lot.
We are a third world country. We just don't know it.

Do you what happened in Canada, the U.K., the Netherlands, Australia, and France? Two weeks after universal health services were instituted, all of the doctors quit and became dogwalkers, waiters, high school guideance counselors, and trashmen.

Except in the UK. I think they call the last group "dustmen" there.

"- W-B would be a much harder sell to EVERYONE, Democrats and Republicans alike, because it's so much more disruptive. It'd probably be that much easier to spread FUD about too. Heck, some of the current FUD would even be halfway true if said of W-B."

As applied, maybe, but minor tweaks keep everything that is better without losing much of importance. (The major complaint about it is that arguably it would dump everyone's coverage all at once and force them to replace it. This could be fixed by only requiring participation if your current plan didn't meet minimum specs). And I'm not sure why you think it could be more easily attacked. The players you don't like are already crying socialism. The problem with hyperventilating over everything is that they can't differentiate. What are they going to say now? This is really really socialism? This is really really really socialism?

"Both are terribly flawed and neither offers a viable alternative to the average citizen."

Which seems to be what Obama's public option provides, a viable option.

I understand Holland is an example of a country in which the public option has been gradually phased out so there is an example where the private insurance companies prospered.

Jesurgislac has answered you with respect to UK's NHS, Canada, using a single payer model in each province, spends 1/2 what you do on health care with better results.

As applied, maybe, but minor tweaks keep everything that is better without losing much of importance. (The major complaint about it is that arguably it would dump everyone's coverage all at once and force them to replace it. This could be fixed by only requiring participation if your current plan didn't meet minimum specs). And I'm not sure why you think it could be more easily attacked. The players you don't like are already crying socialism. The problem with hyperventilating over everything is that they can't differentiate. What are they going to say now? This is really really socialism? This is really really really socialism?

Again, your argument is halfway valid if you arbitrarily limit the policy universe to "Wyden-Bennett" or "Obama".

But that's setting up a false dichotomy. If you decide that the Obama plan is too much compromise, and won't get Republican or moderate support anyway, the fallback isn't automatically Wyden-Bennett. There are many other options.

I certainly haven't seen any arguments that Wyden-Bennett is actually objectively the best possible system. It might be arguably better than "Obamacare", but not necessarily to all of the endless other permutations of single-payer, socialized, or public/private combinations. And Wyden-Bennett is something of an institutional and political compromise itself - its key advantage seems to be its ability to get insurers to halfway go along with it (thanks to Wyden's extensive consultation with them).

But that "advantage" seems to make it that much harder to sell to liberals (and even not-so-liberals), who are, perhaps rightly, going to see it as a sellout to the insurance companies. I'm not sure that's really the political trade off you want to make right now. Insurance companies are actually in a very tight spot. They're wounded, weak, with former allies abandoning them. And near universal frustration with the insurance companies is one of the few really good rallying calls reformers can use.

McKinneyTexas: Why is NHS relevant? Because it is an example of what a nationalized system can become.

Yes - pretty damn good, no? Costs just over half what the US spends, best access in the world, low bureaucracy, and achieve better results than the US in almost every area of healthcare.

If today's US system is bad, don't think it can't become worse.

Brrr. Yes - rescission's stepping up as health insurance companies realise that the cheapest way to keep growing their profits is to refuse to pay out for any expensive healthcare. That's only going to get worse, and the more people are stuck with using the emergency room as their sole source of healthcare, the worse the overburdened ER system is going to get - you already have people dying in the ER queue.

Market forces are already a strong factor in why the US has the worst healthcare system of any developed nation, and are the main reason why your healthcare system will only keep getting worse: market forces mean the system primarily delivers profits, not healthcare.

I'm a bit at a loss why you prefer to stick to the worse system and watch it getting worser, though, McKinney. Got a death wish?

(hope this doesn't double-post, Typepad ate it the first time)

von: "because the Democrats will not bring it up. And that's frankly dispicable: politics at its narrowest and worst."

*rolls eyes* Yes, the fact that the Democrats haven't brought up your pet bill is politics at its "narrowest and worst". Not because it's even more controversial than the half-measures they're currently contemplating, or because they tried to pre-emtively address the Republican criticisms (for all the good it did), or because the Republican "support" for W-B is a complete illusion.

Also, as a practical matter, when none of the Republicans are going to ever vote for a Democratic health care reform proposal, why on earth should they propose something because it appeals to Republican bloggers in no position of power? Which is why they should have just gone for single player, because it would have gotten the same exact Republican attacks, and the same amount of Republican support in Congress, to whit, none.

Sebastian: W-B would be worse in many ways than single payer, and a harder sell to the liberals who don't support the current plan because so much of it's half-assed and pre-compromised to try and win over Republicans who can't be won over.

Seriously, I don't get the wide-eyed innocence here. Why are von and Sebastian shocked, SHOCKED, that the Democrats haven't put up their preferred wonky bill, as opposed to any of the other wonky bills that could have been proposed and work better than the current plan, and would be just as hard a sell to Republicans, but actually get Democrats excited?

mckinneytexas: Yeah, I'm sure those 1 million Brits are worse off than the 47 million Americans who don't have health insurance of any kind, so go without treatment for things until they become acute, or the Americans with insurance who go bankrupt because of medical bills, or the Americans whose treatments are denied by private bureaucrats (much better than
government ones!) or...

Or maybe the fact that the NHS isn't perfect, isn't a good argument against reform here, because we're a LOT further from perfect, oh, and the NHS isn't what's being proposed here anyways.

[i]many 'reform' proponents desire something more akin to Canada's or the UK's system. Both are terribly flawed and neither offers a viable alternative to the average citizen.[/i]

Based on what I've seen and read, Canada's system is, while not perfect, clearly superior to our own. I have relatives up there who would, I guarantee you, not wish to trade it for our system. But then my sister is a teacher and therefore clearly a socialist suckling at the teat of society.

The great fear appears to be that, by getting the poor into the system properly, we will reduce the quality of care for the ~85% who currently have access (either by overloading the system or by bankrupting ourselves). For one, I don't believe that is true (except, perhaps, in the short-term, because there will be some inevitable disruption), based on the examples set by other advanced nations. For another thing, that boils down to "I've got mine, screw you." Which I reject as both morally wrong and practically stupid.

I get that the seniors are worried. They're old, they need lots of healthcare, they've got it now, and old people are generally resistant to change. They know they've got a really sweet deal and they're concerned that the youngins will make it less sweet. They're politically powerful (and, as their numbers swell, will get even more powerful), so I seriously doubt they've got much to worry about, but there you have it.

The Dems definitely need to do a better job, and I think that involves two basic things: 1) accentuate the positive; and 2) quit worrying about pleasing the GOP, which has absolutely ZERO intention of meeting in the middle.

The outrage from the conservatives that the Democrats are not advancing their preferred plan is a little hard to stomach. Here are some of my thoughts:

1. why should i care what you think? you're my political opponent. Elections have consequences.

2. Politics is the art of the possible. There's always a "better" bill stuck in committee someplace and that's usually because the chair of the committee isn't willing to take on the opposition to that bill. That's just life.

3. The opposition looks like alligator tears to me. The moment that the Democrats start pushing the alternative bill, two things will happen: (a) Republican support will vanish like morning dew under the desert sun; and (b) hit pieces will come out about Democratic hypocrisy and spinelessness.

Thanks for the advice. Really. We'll take it with the seriousness with which it was delivered and place it in the circular file where it belongs.

"And I'm not sure why you think it could be more easily attacked. The players you don't like are already crying socialism. The problem with hyperventilating over everything is that they can't differentiate. What are they going to say now? This is really really socialism? This is really really really socialism?"

Honestly, YES. Watching the Right of late leads me directly to that conclusion.

The Club of Growth just started attacking Bob Bennett. Why? Because of the HAA. Apparently Bennett's a no good commie bastard for proposing it.

Seriously. That's EXACTLY what will happen if the focus shifts to the HAA.

Backup, with link:

"The Club for Growth took a significant step Tuesday toward opposing Sen. Bob Bennett (R-Utah) in the GOP Senate primary.

The Club announced an advertising and letter-writing campaign targeted at the 3,200 likely delegates to the state Republican convention. Those delegates will have a big say in who the party’s 2010 Senate nominee is.

It is sending a letter to each of the delegates and running an ad hitting Bennett for advocating “government-run healthcare” — a reference to the healthcare bill he authored with Sen. Ron Wyden (D-Ore.).

The ad says Bennett is teaming with “liberal Democrats” and features a mock Bennett website detailing the costs of the plan.

The ad says the proposal “pushes you out of your current plan,” and that will result in job-killing tax increases.

The Club says the effort is part of a $1.2 million campaign battling the current healthcare proposals. But the effort focuses on the Bennett-Wyden proposal, and the targets of the letters are notable because of the electoral situation Bennett finds himself in."

http://thehill.com/leading-the-news/club-for-growth-puts-sen.-bennett--in-crosshairs-2009-08-25.html

Awesome, eh?

Washington Monthly is reporting that the RNC has sent out a healthcare questionnaire asking if it concerns citizens that a reformed healthcare system with a public option might try to identify voters' political affiliation and thereby deny REPUBLICAN voters their healthcare.

I've got to admit that I hadn't thought of this, wrapped up as I am in appointing the death panels, hiring the death squads, and what to do with granny's fillings - send them to Larry Kudlow to add to his stash for the gold standard, or what.

But this sounds like an efficient, money-making move we shouldn't pass up.

Let us deny Medicaid and Medicare services to older Republican voters and put the unspent money into the defense budget, the latter of which is not a government program either, so I'm told on the internet.

As for the public option under discussion, denying younger Republican voters healthcare and hastening their deaths would benefit the nation in myriad ways -- not only by saving money -- but by doing away with Republicans when they are in, or before, their prime, peak Nation-ruining years.

After all, Republican grannies are done screwing up the country and look forward to their emeritus years of only occasional lying and stupidity.

The RNC is a font of good ideas. Michael Steele appears so effing ignorant on T.V, but the guy is a deep thinker after all.

"Again, your argument is halfway valid if you arbitrarily limit the policy universe to "Wyden-Bennett" or "Obama".

But that's setting up a false dichotomy. If you decide that the Obama plan is too much compromise, and won't get Republican or moderate support anyway, the fallback isn't automatically Wyden-Bennett. There are many other options."

Actually we have no idea what the "Obama" plan looks like, which is probably an enormous part of the problem. I'm drawing comparisons between the current House plan and Wyden-Bennett. Do I think Wyden-Bennett is the best possible plan in the universe? No. I think my Medicare for the uninsured is much better, but whatever.

My point is that "The Republicans will oppose anything THEREFORE Democrats can't propose better plans" is a nonsensical argument. I wish people would either stop using it, or would make it a logical argument. But at this point, any time anyone comes up with any useful tweaks or anything better than the rather bad House plan, the response is "We can't do better because the Republicans oppose everything." So what? They oppose the House plan too. So "Republicans oppose everything" is an argument against the House plan too.

No government subsidies for the public option? Seriously? And suppose premiums are insufficient to cover costs, will the option fold, file for Chapter 11? This is why so many people are coming around to the view that proponents will do and say anything to get this thing they call 'reform' passed.

As for doctors leaving the profession, the ignorance at this site and in the debate generally from the 'reform' side of medical protocols, levels of training and specialization, the level of training and what has to paid for someone willing to make that commitment and, most importantly, the impact of disparate training and skill levels on outcomes is astounding.

Doctors are not fungible, period. There are good, great and awful doctors. A GP or family doctor cannot competently perform even the most basic surgeries. Extensive training is required to create a competent neurosurgeon, orthopedic surgeon, cardiovascular surgeon etc. The people who do this expect to make a very, very good living. They expect this for several reasons: they have deferred making any money for more than a decade, they are very good at what they do and what they do is very hard work. They will not work for peanuts. Fewer and fewer qualified people are going into the high surgery fields. In time, quality surgery will become rare and difficult to acquire because those limited and competent high end surgeons will be in great demand while the quacks practice their own brand of butchery on the unfortunate masses the cost of whose care has been driven down by artificial, nonmarket forces.

This process has already started as private insurers tie reimbursement rates to medicare rates. Medicare rates have surgeons performing 4 hour operations and getting paid $1000-$1500. It is a ridiculously unsustainable load on high end specialists. It will get much worse under nationally managed care. The proof lies in the present state of affairs created by Medicare.

Sebastian: the argument against W-B isn't "The Republicans will oppose it", it's that they will oppose it, so why bother proposing something like W-B, which was designed to try and appeal to Republicans, and instead just propose straight up universal health care like the rest of the industrialized world.

Actually, that's not even the real argument, the real argument is W-B is pointless to discuss, because if the House bill is defeated, there won't be any kind of health care reform for at least a decade.

"W-B would be worse in many ways than single payer"

In what ways? And are you admitting that single payer might not be good?

"Seriously, I don't get the wide-eyed innocence here. Why are von and Sebastian shocked, SHOCKED, that the Democrats haven't put up their preferred wonky bill"

Who is shocked? We just aren't buying that the form of the bill is based on the innate basic goodness of Democratic Party leader intentions. I'm not sure what you want from us, or people in general. Is it really the case that we can't draw objections to obviously stupid parts of proposals, or point out where things can be better? Is it really true that the current House bill is such a specimen of excellence that no pressure should be attempted to make it even the slightest bit better? What exactly do you want other than STFU and pass any darn thing the Democratic leadership comes up with?

The Republican Party can't be a good (and I mean that in the normative sense) opposition party at the moment because it is led by effectively insane people. Does that mean that NO ONE ought to try to point out where the Democratic Party can do things better? Does that mean that NO ONE ought to try to make things better than whatever comes out of Pelosi's mouth? What exactly do you want?

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