Cutting "Costs"

by publius

I'll admit that this article doesn't make me feel very good about the end product on health coverage reform.  I get the sense that Obama and the leadership are going to give away too much -- even beyond the public option.

My most immediate fear is simply that the subsidies will get excessively cut in the name of budget hawkism.  As is usually the case with anything associated with "hawkism," it's a superficially attractive label that masks a totally absurd and noneffective policy.  The only thing that cutting subsidies will accomplish is to make life very difficult for working class people who will be mandated to buy insurance, but who earn too much much to qualify for a subsidy.  You wouldn't really be cutting the costs of anything -- you'd be reallocating them to these families.  It's bad policy, and even worse politics.

But such things happen when you let Kent Conrad and Max Baucus be the most important people on health care, and when ideology dominates over factual reality.

Comments

[edmund dantes]

Let's be honest. At this point, it sounds like all intents and purposes we are going to get a bill that is predicated on the basis of "getting something done". The bill isn't actually going to change anything. It'll make changes around the margin. It also has high potential for doing more harm than good.

Here's the thing though. Even if the bill sucks because the Dems and Obama gave away things to look bi-partisan. Gave away needed reforms because they may cost too much. Etc.

When the bill fails, and it fails specaturaly all of that isn't going to matter. It's going to be the Democrats failure.

So if it's going to be your failure no matter how much you try to bring in others for cover. Why not go all out? If it fails, you lost nothing since you were going to get raked over the coals anyways. If it succeeds, you gain some political points, but even better you actually have changed the world for the better.

I know that isn't a high priority, but let's look beyond the "politics" of the moment and actually do something for the common good as opposed to trying to get political cover from a token or two republican votes.

[John Thullen]

If the bill fails, then I want Medicare and Medicaid abolished.

Don't dare to ever tax me for these commie Republican programs.

[brent]

That article is depressing but somehow I don't really believe its the truth. The White House has to know that these concessions will buy them nothing. Like all politicians, Obama doesn't want the perception of having failed on his record, but he is also not stupid. He can see what we all see which is that watering down this bill even further seeking out Republican support is an exercise in futility in addition to being bad policy and bad politics. I know predicting when any politician will actually show some backbone is a "mug's game" but really I do think the Obama team knows better than to gamble on some sort of bipartisan compromise at this stage.

[elm]

I wouldn't be surprised to see a final bill consisting of: mandates, some subsidies, and some regulation. That package is essentially what the insurance companies proposed this spring. It could probably get some token Republican support.

To me, that bill would be worse than the status quo. I have little confidence in regulation alone, especially when applied to giant companies. But that's what happens when you go into negotiations with the attitude "It's so important to get a deal, he will do almost anything it takes to get one."

[John Thullen]

Further, Steve Benen reports at Washington Monthly that Democrat David Price of North Carolina was told in advance by a television network rep that his healthcare townhall meeting would not be covered "unless it blows up".

The crowd was largely receptive and respectful, but did not make the news.

These are the newly perfected and debased rules of political discourse and so-called news coverage in this sorry excuse for a country.

Going forward, I never want to see so much as a ribbon-cutting ceremony by any filth Republican politician without armed, angry, threatening, dangerous crowds bussed in to make sure the thing gets covered.

Feed the beast until the beast eats everything.

[publius]

agree with all this -- the problem is that they're making it a bad bill, which they will own.

the other problem (i did a post on this a while back) is that it's very hard to achieve this piecemeal. once you jump in and add something like pre-existing condition bans, then you have to have mandates to get people then,t hen subsidies, and on we go

[Johnny Canuck]

edmund dantes and elm, surely the issue is the mathematics. Reconciliation is problematic. Without sixty votes republicans can cause havoc in the Senate. There are many other issues that need to be addressed. Climate change legislation is being delayed because health reform is absorbing all the oxygen.
I understand that when medicare/medicaid were introduced, there were many exceptions that were subsequently dealt with.

From where I sit, Obama arrived to captain a leaky ship. There were many leaks. If the majore leaks aren't addressed the ship will sink- not soon but in 10-20 years. So there is a quibble over whether to install a super pump, a moderate pump or a mini pump to deal with one of the leaks. Rationally a super pump is really necessary, but so clear there would be a mutiny, Obama proposing a moderate pump. Better to have some pump even a mini than none at all, move on to deal with another leak and maybe come back every year to try again.

[Sebastian]

I actually think that subsidies are pretty much the only really good part of the bill as it (sort of) exists. They actually fix an important problem--that of uninsured people who can't afford it.

It is the revamp of the rest of the system that I'm not thrilled about.

"the other problem (i did a post on this a while back) is that it's very hard to achieve this piecemeal."

It happened piecemeal in France and Germany, so I'm not sure this is true.

[edmund dantes]

Ahhh... the classic "there are bigger/other battles" that need to be fought so we need to compromise on this one to get anything even if it's a moderate or a mini pump.

The problem is this pre-supposes several future considerations which aren't a given.

1) Someday in the future there won't be a "bigger" "other" problem excuse being offered. <-- I don't think Vegas would even give you odds on this one.

2) You will continue to have the legislative numbers to push through the "fixes" or "piecemeal" solutions in the future(especially considering failure to deliver meaningful results on one of your key election platforms). <-- This is game changing legislation when it comes to solidifying and locking in electoral advantage. We're horsetrading it away for one or two votes

3) Also assumes the piecemeal or moderate pump does no harm or creates problems that can't be used to terrorize voters or can be demonized by opponents. <--- hmmm... I'm pretty sure Vegas won't give you odds on this one either.

I could go on. I think reconciliation is a sign of the weakness in the democratic caucus. It shouldn't even be a consideration except as a last resort, but as Dem leaders are want to do we jump right to our endpoint and negotiate from there. I've never understood that dynamic.

If you can't even get a piecemeal or pump solution through the senate without resorting to reconciliation, you might as well give up the ghost. You are dead.

[Free Lunch]

At some point, the 'reform' is so distorted that the current disastrous system is better. We don't need another erroneous reform like the Medicare Part D giveaway to insurers and 'ethical' drug companies that happened to help the elderly for only about three times the cost of directly including it.

The Democrats have caved on reform. It's hard. There are a lot of oxen to be gored. Buying off every constituent organization that will be affected is not possible. The cost is too high.

[russell]

It happened piecemeal in France and Germany, so I'm not sure this is true.

I'd go so far as to say that piecemeal is the only sane way to go about it.

Who knows what's going to work, and what isn't? And every thing we tweak or fix is going to make some other part of the system work differently.

What I'd really like to see if we're going to continue to rely on private insurance providers is a requirement that they spend more than 80% of revenue on actual health care. 90% should be a minimum. They are currently both more expensive *and* less efficient than the public offerings. If they can't make a living on that basis, they need to find another line of work.

Whether we rely on private or public insurance providers, we have to get coverage for basic health care -- not just catastrophic coverage, but coverage for stuff like checkups, medicines, pre-natal care -- extended to as close to 100% of the population as possible. Right now 15% have no coverage *at all*. The number of folks for whom basic care is a financial hardship is probably more like a quarter of the population.

Any bill that doesn't achieve both of the above is, IMO, a failure. Especially the insurance coverage part, that has to be non-negotiable.

Otherwise what's the point? We already have patchwork, incomplete coverage that is widely disparate in what it makes available to people. If all we're doing is trading for a different version of that, why bother?

Especially if the biggest change is just relocating the burden of payment to individual consumers. At that point we're just in "free to sleep under the bridge" territory.

[elm]

Johnny Canuck, what do you think the super, moderate, and mini levels of reform are in this instance?

To my mind, top-tier reform would give everyone an alternative to for-profit health insurers. Publicly-run insurance that's available to everyone would fit my criteria.

Moderate reform, includes publicly-run insurance with restricted access (restricted in ways that favor the insurance industry). That's the public option that has been on the table.

Mini reform, then, is the best case for a mandate, subsidize, and regulations approach. If (when?) the insurance industry captures its regulatory board those regulations will be turned to favor insurers over the insured. That approach may or may not be better than nothing, depending on the details.

The Democrats' message has been muddled and confused at best. At this point, I don't know what Obama even wants or is willing to fight for.

I understand that the Republican Party can cause trouble in the Senate, but I believe they will try to sink any climate change bill -- independent of what happens with health care.

[mw]

“Keep It Simple Stupid” is the first rule of sales. Of course this president has never been in business or sales. He is a lawyer and he thinks like a lawyer who is trying a case. Good luck with that.

If I were to guess what the American people really want with health care reform, it would be something that can be articulated pretty simply and emerges from some basic American values of fairness and common sense:

1. Every American gets a baseline level of solid health care. No one is left behind.
2. No American need be at risk of financial ruin or bankruptcy because they get sick.
3. The program is manageable and fiscally responsible. Americans want to feel reasonably certain we won’t see mushrooming costs like with Medicare and the prescription drug plan.

A problem with the ObamaCare HR 3200 hairball is that it at best accomplishes one of the three. Interestingly, the Wyden-Bennett Healthy Americans Act (S 391) actually does accomplish all three. Simple.

[Trickster]

Wow. It looks like he's actually going to blow this. Enacting a bad bill may be the worst possible outcome.

Here's what Obama should do:

(1) Craft his own plan. I'm actually not that big into whether it contains a "public option" or not - that's just a vague phrase that has served as the tag that symbolizes whether it will be a real change or make-believe. What's VITAL is that the HMOs get reined in by hook or by crook. Universal coverage would be nice, but we have managed to get by without it. I don't think we will keep getting by if we don't rein in the HMOs. Our economy will crash but good under that weight - we already got a little taste of it.

2. Obama should offer his own real plan that brings the HMOs to heel after the recess. No negotiations unless they're real. It's an offer Republicans can't refuse.

3. When they do, run on their obstructionism. Health care and Republican obstructionism should be the only issues on the table for 2010.

Simple as that. So far Republicans have won a smashing PR victory by floating a ton of BS - but Obama has a louder megaphone. If he starts saying something simple and consistent about his own plan, well it's probably too late to get anything real this year, but #3 above should lead to real reform in 2011.

[brent]

Except mw, that the Wyden-Bennett bill would have been just as contentious, by the time the opposition got to it, as hr3200. The simple fact is that the 3 principles you espouse are basically identical to the principles that Obama has been espousing all along. The complicated part of this is not in what the Dems want to achieve, it is finding some agreed upon way to get there. And for the most determined opponents of reform, they were always going to vigorously oppose any means of getting there that inconveniences or attempts to restrict insurance companies in any way. The problem with HR3200, which you for some bizarre reason have decided to inaccurately label as ObamaCare, is that it tries to get to a solution without changing too much, precisely because it is trying to maintain as mush as possible of the status quo.

Wyden-Bennett is, in my opinion, a good bill, but it would require basically dismantling our current employer based healthcare system. Is there really any reason in the world to believe that that sort of legislative task would actually be a easier sell than the current operative plans which really don't do anything except add a few common sense consumer protections to the status quo? I doubt it.

[russell]

Interestingly, the Wyden-Bennett Healthy Americans Act (S 391) actually does accomplish all three.

Interestingly, it's far from clear that that is so.

Universal coverage would be nice, but we have managed to get by without it.

Who is this "we" you speak of, kemosabe?

[Marty]

"Wyden-Bennett is, in my opinion, a good bill, but it would require basically dismantling our current employer based healthcare system. Is there really any reason in the world to believe that that sort of legislative task would actually be a easier sell than the current operative plans which really don't do anything except add a few common sense consumer protections to the status quo? I doubt it."

Well, you would get a huge upsurge in employers supporting reform......

[elm]

Marty, Wyden-Bennett includes additional taxes on employers and a mandate that they increase employee pay by an amount equal to the employer's contribution to health insurance. The Chamber of Commerce would never support that.

[Marty]

"Marty, Wyden-Bennett includes additional taxes on employers and a mandate that they increase employee pay by an amount equal to the employer's contribution to health insurance. The Chamber of Commerce would never support that."

Well, most of us who would be doing it would. It becomes a fixed cost (at least by percent) over time at that point, essentially, rather than a random annual increase. It also takes the anger of employees away from the company as rates go up. Lots of good stuff for employers here, trust me.

[brent]

You beat me to it elm, but yes, The Chamber of Commerce and small business groups in general were never particularly enthusiastic about Wyden-Bennett. What it all comes down to is this: reform, any type of reform, is always going to come at some cost and the people who have to pay those costs are going to be opposed to it. Its one of the principles of politics I suppose that it is necessary to pretend for as long as possible that we can make major adjustments to a system without levying those costs but at some point, the bill will arrive.

Wyden-Bennett or any fantasy alternative proposal that actually has any chance of improving the system would be the same. Its pointless to believe otherwise.

[GoodOleBoy]

I support regulation that somehow gets at the 'pre-existing condition' issue and also subsidies that are designed to assist those who want insurance but cannot afford it. I do not support mandates.

My recollection on when I signed up for Medicare Part B is that the information provided included a 'warning' that if you don't sign up now but wait until some later date and want to sign up, the premium at that future date would be sufficiently higher to account for those years where you did not participate. It seems to me that something along these terms could be included in any regulation requiring insurance companies to insure those with pre-existing conditions. So, if a healthy adult avoids insurance premiums, by choice, for 30 years, but at 50 years old acquires a serious or chronic medical condition and decides they want insurance coverage, there should be a allowance for a provision that includes an amount in their premium to make up for the time they did not insure. This is not a mandate, but it should be an incentive to carry insurance through healthy periods.

I happen to believe there is a way to deal with every issue presented through private insurance, regulations, and tax subsidies. After all, if we put everything in the hands of the government, all will be paid through taxes, but much of the benefits of choice and competition are gone. The same thing can be done with insurance. Premiums will have to increase across the board. Incentives should exist to get broader participation by young, healthy people.

Efforts should be made to shift coverage payment from employers to individuals along with the tax benefits. Would this mean that employers could not negotiate a group plan for employees, I don't know.

Anyway, I see no need to scrap what works, even with warts, for more than three quarters of our people and turn it over to the government.

[Jay Jerome]

“Keep It Simple Stupid” is the first rule of sales. Of course this president has never been in business or sales. He is a lawyer and he thinks like a lawyer who is trying a case. Good luck with that."

That's right. The first problem with HR 3200 is its language... It was written by and for lawyers and bureaucrats, and is undecipherable, as ambiguous as an ink-blot spill. To understand what the hell any of the sections mean requires 'interpretations' from partisans on both sides, who spin the translations to fit their own objectives..

Here's an example:
(ii) EXCLUSION OF CERTAIN READMISSIONS.-For purposes of clause (i), with respect to a hospital, excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the Secretary) of discharges for such applicable condition for the applicable period and such hospital.

Huh? WTF does that mean, and who you gonna trust to tell you? Republican lawyers? Democratic bureaucrats? Big Labor or Big Health Insurance execs? And how do you know how future lawyers and judges will interpret the sections, so that what was projected to cost a trillion dollars ends up costing five trillion?

The bill has too many holes, too many uncertainties concerning the negative or positive effects that will cascade from it, too much double-talking gobblygook to trust it. In other words, don't buy a pig in an incomprehensible poke.

I want the bill put on hold. O-Blah-Blah should focus on fixing the economy first. Get people back to work, and cash flowing, and then he'll have some creds with the public. That's what FDR did in his first term: started the Public Works Administration, and the CCC, etc -- and put millions of people back to work fixing and building bridges and roads and airports and dams. Those programs made him popular enough to get reelected, which enabled him to push through the Social Security Act in his second term, legislation which faced way more opposition in its time then Health Care is facing now.

Aside from smoozing with foreign dignitaries and making speechifying public appearances, O-Blah-Blah hasn't proved he's capable of doing much of anything right. So far, he's shown only a flair for chatter, a talker and not a doer.

In other words, fix the economy first, stupid. Because if you don't there won't be enough money for universal health care, or for Medicare or Social Security either -- it will all go down the tubes.

[russell]

FWIW, here is a pretty good brief analysis of Wyden-Bennett.

I frankly don't care whose bill gets passed as long as something close to 100% of folks can go to the doctor get whatever treatment and/or meds they need.

The sheer amount of wealth generated by the US economy is, basically, staggering. Even in the current context. It's insane, and ought to be a point of shame sufficient to get us off our damned @sses, that anyone living here should be unable to go to the doctor due to inability to pay.

Seriously, WTF. Let's just get it freaking done.

[brent]

The first problem with HR 3200 is its language... It was written by and for lawyers and bureaucrats, and is undecipherable, as ambiguous as an ink-blot spill.

The point of all of the sort of legalistic language and indeed the language of legislation is precisely to avoid ambiguity. Contrary to your point, the less legalistic and specific the language of a bill, the easier it is to misinterpret. Keeping it simple, in other words, is not an option if we want to make sure that law is applied consistently.

I don't know the meaning of the passage you quoted but if I spent the time follow its cross references and the terms that it no doubt specifically defines, as all legislation attempt to do, I bet I would be able to figure out both the meaning and intent of the legislature. The principle of keeping it simple would in no way allow me to do that and, in fact, makes it far easier for me to interpret it just about any way I want.

As for putting the bill on hold, that is a non-starter because it disregards the politics of the legislative calendar and the general uncertainty of politics period. Democrats want to reform the system in significant ways. Republicans, in general, think the status quo is just fine. Inertia is always a powerful force, especially in the Senate, and right now, the Democrats have about a strong a legislative advantage to fight that inertia as they are ever likely to have. What Obama needs to change the system is not "cred." What he needs is votes and it is unlikely that he will ever have more assured votes for any significant change than he has right now. In other words, there is no later. Putting it off until later would be an extraordinarily poor strategic move on his part and thankfully, he knows it.

[GoodOleBoy]

'I frankly don't care whose bill gets passed as long as something close to 100% of folks can go to the doctor get whatever treatment and/or meds they need.'

I agree, provided we do it to the maximum extent possible without government involvement.

The statement also made me wonder about public service. We will have a shortage of doctors, nurses, and maybe other medical practitioners and technicians. We also are looking at some continuing unemployment. Why not a public health service that trains or pays for the education and training of candidates to fill these jobs with the provision of a stipulated future period of service in medically underserved areas?

[brent]

Why not a public health service that trains or pays for the education and training of candidates to fill these jobs with the provision of a stipulated future period of service in medically underserved areas?

All of the bills under consideration include significant funding for the training and encouragement of more primary care physicians.

[cleek]

It was written by and for lawyers and bureaucrats...

of course it was; health insurance is a legal and bureaucratic topic. you'd prefer they wrote it in LOLCat ?

Sec 33.12

A/ i Cn haz treament?

i. U pay the grrl @ desk, U get pill.

ia. and chzzburger?

ii. deny cheezburger

iia. tyrannee!

iii. next payshunt plz.

[russell]

I agree, provided we do it to the maximum extent possible without government involvement.

As is no doubt obvious from my comments throughout this discussion, I really don't give a crap how involved government is, or not. I don't understand the conservative animus toward government, it makes no sense to me, and to my eye it does nothing but undermine people's confidence in worthwhile public institutions.

The kind of stuff we're talking about here is conceptually quite simple. You do the actuarial math and figure out how much money you have to put in the kitty to cover the statistical likelihood of folks getting sick. Then, when they get sick, you pay their bills.

It is, no doubt, sophisticated math, but the principle is pretty damned simple.

The government does this now, today, for fairly large swaths of the population, and does a reasonably good job of it. At least as good as the average private vendor, except more efficiently and at lower cost.

I don't see the freaking problem.

You, and lots of folks like you, appear to have some principled objection to solutions offered through public institutions. By "principled" here, I mean it's based on some abstract principle, rather than a pragmatic consideration of the actual, tangible pros and cons.

That's all well and good, and far be it from me to impugn anyone's political ideals, but if it gets in the way of people being able to go to the doctor, I think it might behoove you to lighten up and give it a rest.

People are dying over this. Your personal scruples about your "personal liberty" might have to take a back seat.

[Hogan]

Those programs made him popular enough to get reelected, which enabled him to push through the Social Security Act in his second term, legislation which faced way more opposition in its time then Health Care is facing now.

The Social Security Act was passed in 1935. The vote was 372-33 in the House and 77-6 in the Senate. So, no, and no.

[brent]

You do the actuarial math and figure out how much money you have to put in the kitty to cover the statistical likelihood of folks getting sick.

Unfortunately russell, it gets a lot more complicated than that because there is also 1) the math involved in figuring out how much getting a sick person well should cost and relatedly 2) figuring out to what extent free market forces should be allowed to exploit the situation by determining those costs. I know what I believe of course, which is that public health should not be treated like every other market product but rather in the way of most other Western countries as a basic right. My only point, and I doubt you disagree, is that I cannot deny that these are also important questions that go well beyond the "math" and upon which there can be reasonable disagreement.

[russell]

Actually, I'm not sure I agree.

I'm with Marty on the idea of separating the issues of coverage and cost of delivery. In other words, the first priority is to get everybody covered. Then you can circle back and start figuring out how to dial costs back.

IMO there is no particular amount that getting well from a given illness "should" cost. Some people recover from flu in two days, some in two weeks. Some people recover from major surgery in a week, some in a month. Some women deliver their children in a few hours with no complications whatsoever, some encounter problems that require extraordinary and expensive measures. Some people can be treated for certain illnesses with common, inexpensive medicines, some require other treatments due to allergies or other conditions.

There's no way to tell what any one round of treatment for a particular illness will cost. I doubt you can even do a reasonable job of enumerating all of the possible factors that might come into play for some situations, let alone what the cost will be.

We *do* need to be reducing the overall cost of medical care, because it's growing so large and so rapidly that we will soon simply not be able to afford it, no matter what approach we take. IMO the place we should be focusing is in the areas of public health -- diet, exercise, preventive care. Not in the sense of "your BMI is too high, no care for you!", but in the sense of providing simple, positive opportunities and inducements for people to improve their health.

As far as I'm concerned, "free market forces" have had their crack at delivering health care and reducing costs, and have done a crap job of it. My opinion, basically, is that in the area of providing health care insurance in particular the "free market" either needs to demonstrate good faith and earn some credibility, or else they deserve to have the pie taken away from them.

I don't necessarily see health care as a basic right, I just see it as something extremely important and valuable. Far too much so to rely on purely self-interested actors to insure its availability.

[brent]

There's no way to tell what any one round of treatment for a particular illness will cost. I doubt you can even do a reasonable job of enumerating all of the possible factors that might come into play for some situations, let alone what the cost will be.

Sorry. I am talking about the average costs per person over time and the factors that determine those costs. So of course, every course of treatment is different, but to get to your math, to figure out how much money we need in the kitty, we have to make decisions about how, for instance, to deal with drug prices and there are different ideological approaches that are important to sort out. We can change market rules to allow more competition between drug companies or we can engage in negotiation as a large single payer, a la medicare, to set the prices we will pay. There are, of course, many other options, including doing nothing at all, but the point is that there are those who can bring reasonable arguments to bear across the ideological spectrum.

And I believe you have to sort those issues before you get to your mathematical calculations of how to pay for it. I think, for instance, that it is a mistake to create a system of universal coverage by simply implementing mandates and subsidies without firmly establishing how we intend to cap and control the associated costs. Otherwise, it is just a boon to the private industries who have no incentive, public or private, to contribute a single cent of their considerable profits to the public well being.

In other words, it all boils down to a question of just how you figure out how much money you need and that question is just as ideological as it is mathematical.

[russell]

Fair enough.

My point overall here is that it's not something that the government is incapable of doing, and doing well. They do it now for millions and millions of people.

I'm talking about the insurance piece, not the actual provision of care.

I recognize that ideology comes into play, but I think it behooves us all to put our personal political inclinations to the side on this one.

[mw]

@Brent
I identify HR 3200 as ObamaCare because it seems that is what the administration is doing. If you can tell me what bill David Axelrod is defending in detail in his Aug 13 chain-mail I'll correct my identification. Regardless, I should have been more precise and identified it as ObamaCare 1.0, as we will need to wait until Wednesday to find what ObamaCare 2.0 entails.

Yes, the 3 principles I outline are indeed a subset of the many and shifting health care reform principles outlined by Obama. That is kind of the KISS point. He would be better served selling reform by focusing on a few key points that truly resonate and stick with them, rather than throwing in a lot of ginsu steak knives like free annual physicals and end of life counseling.

In terms of comparing the plans, it is very defensible that Wyden Bennett accomplishes all 3 principles equal to or better than HR 3200. The official House site for HR3200 posted by its sponsors says it will cover 97% by 2019. The independent review of Wyden Bennett linked by Russell says it covers 99% in far less time. The CBO says HR 3200 will cost $1 trillion and need new taxes. The CBO says Wyden-Bennett pays for itself and is deficit neutral. I give them a tie on protection against financial disaster with guaranteed coverage, elimination of pre-existing conditions and portability.

I agree that Wyden-Bennett would change for the worse as it makes its way through the legislative intestines and would be just as difficult to pass as any other real reform (pun intentional). But - It does come with GOP cosigners. Even if some of them are just cravenly using it for political cover (which some certainly are) - equally certainly some will stick with it - Bennett, Graham and Snowe will all vote for it - and that is 3x the republican support that ObamaCare has now, even if Obama prostrates himself in front of Snowe for a watered down ObamaCare 2.0. Three GOP votes provide a lot of cover for Conservative Dems to stay in line.

I think the thing that people are under-appreciating, is that there is such an animal as a principled fiscal conservative in both parties. And they will compromise a lot on everything else, if they can get a deficit neutral, no net new taxes reform bill. Wyden Bennett offers that and is a better foundation to build anew.

[brent]

He would be better served selling reform by focusing on a few key points that truly resonate and stick with them, rather than throwing in a lot of ginsu steak knives like free annual physicals and end of life counseling.

This point confuses the messaging with the content of the bill. Any good bill will contain these sorts of details or some other set of details that its opponents will find some way to attack. He is not out there trying to sell this bill by talking about end of life counseling. He is out there flogging, ad nauseum, almost exactly the priniciples you suggest and that approach, the KISS approach, is exactly whats failing. Indeed the primary criticism of his approach so far has been that he is doing to much of keeping it simple and not leading by informing both the legislature and the activists out there trying to sell this of what he would like to see in the bill in more specific detail.

As for Wyden-Bennett, again, nothing he is proposing in the bills that currently exist are anywhere near as radical or transformative as what the Wyden Bennett bill attempts to do to healthcare. There is a reason that his bill has basically been ignored by both the right and left ends of the legislature and whatever anyone is saying now, the idea that a majority would have the courage to end up supporting a bill that

1. is disliked by both unions and the chamber of commerce,

2. would involve telling most of the American people that they could expect to have to change their current coverage,

3. that would involve a major adjustments to popular programs for the poor like Medicaid and SChip basically dismantling them and pushing people into the private market

4. that would actually replace the health care that millions of federal employees currently have and are very happy with by throwing them into a far less predictable private market

that that bill was more likely to win 60 votes is highly questionable to say the least. No frikkin way.

As I said, I think its a good bill and deserved some serious consideration but the simple truth is that it was always too radical to fly and both the White House and the Congress which has had this bill in front of them for a couple years now are all quite aware of that fact. Its a fantasy every bit as fanciful as single payer. Was never gonna happen.

[CharlesWT]

[...]
If we give citizens the ability to control their own care, cover pre-existing conditions, and provide resources to the uninsured, we will have fixed health care in America. No bureaucrats. No new czars. No mandates. Just choice and coverage for every American. How to Insure Every American: We don't need radical change. Subsidies and high risk pools can get the job done.