Howard Dean, Ron Wyden, the public option, single payer and the kitchen sink.
Earlier this week, I had the opportunity to interview the always interesting Governor (Dr, Chairman) Howard Dean, who visited Portland last Friday to pump health care reform and specifically the public option.
I asked the Governor about single-payer, and the heavy advocacy it's receiving at town halls and other places from Oregonians. Governor Dean noted that some single-payer advocates aren't interested in dialogue and disrupt events, which is counterproductive. But he said he believes that Obama made a crucial error at the outset of the conversation. "The Administration made a mistake by not bringing them (single-payer advocates) to the table. That's the best way to have real dialogue".
Dean also said that single-payer is pretty tough to differentiate from the public option. "Public option is like single payer. It gives consumers the choice. There's no such thing as a pure single-payer plan anywhere." Dean went on to say that there's absolutely no reason for a wedge between single payer advocates and those who support the public option. In fact, Dean said he believes that it's a recipe for disaster. "It's a mistake to drive that wedge. It's how reform has been killed in the past.", Dean said.
This united advocacy is crucial, Dean said, because without the public option, it's "fake reform".
Dean and I also talked about Senator Wyden's plan. The Governor said that he will not support a plan without a public option, no matter the plan. The choice should be made by the people which option they want, public or private.
There's been a lot of talk lately about where Senator Wyden may or may not stand on the public option. So I (like a number of other) asked Chief of Staff Josh Kardon to elaborate on Senator Wyden's positions.
One of those who has questioned Kardon lately about Senator Wyden's position is McJoan at Daily Kos:
I spoke with Senator Wyden's Chief of Staff Josh Kardon yesterday, and he confirmed for me that Wyden is not going to stand in the way of a day one, national public option and that he remains open to to it "as one tool for addressing some of the most critical issues facing us in health reform, such as controlling runaway costs." The "responsibly and sustainably financed" part of the entire reform package will be the rub. Which is where the rub is for the entire nation, as DemFromCT's Hotline poll post demonstrates.
I asked Kardon to clarify what he means by "responsibly and sustainably financed", and what that would look like. Here's his response (via email):
The Healthy Americans Act was analyzed by CBO and Peter Orzag and it was determined that the Wyden proposal would save money by strangling administrative costs and turning the immoral insurance system on its head. Under his bill, you would sign up for insurance only once in your life, go into one pool with massive market power, and the insurance companies would have to operate under the toughest federal health insurance regulations ever written. The regulations include an end to discrimination on the basis of prior or current illness and "community rating," where everyone pays the exact same rate regardless of age, gender, or health history. His proposal has been found cost-neutral by the only entity whose ruling counts - CBO.This is not to say that Ron will insist on cost-neutrality for the eventual reform vehicle, but he will insist that people sitting at their kitchen tables reviewing the congressional health proposal be provided with independent, reliable information about the actual cost of the plan to their households, both as consumers and as taxpayers. If a plan does not wrestle down the runaway inflation in health care costs, it cannot be called health care reform in any sense of the word. He recognizes that the committee plan may well have significant start-up costs, however, and won't necessarily hold it to the same fiscal standard as that enjoyed by his own proposal.
I'm seeing the road to controlling costs here, but Im still fuzzy on "sustainably financed". Not resisting the start up costs certainly addresses part of it. But I'm hopeful to hear more about what the threshold is for the Senator on how he feels about the long-term financing of the public option..and where the lines are for him. Perhaps Josh will come by here and address that one specifically.
Josh also reiterated that Senator Wyden is "very open to a national public option". When I told him that Governor Dean had concerns about "fake reform", he said that the Senator shares that concern:
Senator Wyden is also worried about fake reform, though fake reform could also include a public option while not do anything about the caste system that exists in the American health care system today. Today, the Medicaid public plan offers such poor reimbursements that for many poor Americans it is similar to having no insurance at all. The Wyden proposal offers everyone on Medicaid an insurance plan equal to what members of Congress receive, fully paid for, and with reimbursements such that every American, regardless of income, would have access to quality health care. Reform that doesn't gain control of spiraling health costs would be fake reform. The reason Senator Wyden's plan can offer everyone the same benefits enjoyed by Congress is that he controlled costs system-wide. A national public option is one potential tool for controlling these costs, and as long as it helps us reach that objective in can be an important and useful element of real reform.
So what would it take for Senator Wyden to get on board in a promotional/advocacy role with the public option? Kardon says that the President and committee chairmen must produce legislation containing a national public option that also meets the Senator's tests for real health reform. Kardon says that he trusts that Senator Wyden will become a very valuable public advocate for all of the bill's elements, including the public option. Senator Wyden is choosing however to highlight and champion portability, reining in health care costs, and raising everyone's health care to the level currently enjoyed by every member of Congress.
Kardon also said that he believes The Healthy Americans Act meets the responsibly financed/real reform test. But he he isn't insisting that the proposal has to be adopted in total by the committees in order for him to be receptive to a public option. "I think that you will see many elements from the Wyden legislation incorporated into the Democratic package, and that is likely to help the package meet his "real reform" and "responsible financing" tests", said Kardon.
Josh also said that Senator Wyden is hearing from many, many single payer advocates and has taken steps based on their good advocacy. "For example - and no one seems to be discussing this - he believes that true reform would end the caste system that exists in American health care today. Some of the health reform proposals floating around today would capture the uninsured by massively expanding Medicaid. Medicaid patients receive, on the whole, fewer choices, and poor access to health care when compared to those who qualify for Medicare and those who have private insurance. A great many doctors will not accept new Medicaid patients, if they take any Medicaid patients at all. Ron believes that every American, whether they are destitute, a CEO, or somewhere in-between, should receive exactly the same services, physicians, and quality of care".
I agree with Kardon that these are all important pieces. But we need Senator Wyden on board and advocating for the public option, not just staying out of the way. It's important that we continue to push the Senator in this direction. I agree with Governor Dean that without the public option, we just don't have real reform.
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June 12, 2009 |
Carla Axtman | Comments (97 so far)
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Posted by: Kari Chisholm | Jun 12, 2009 11:42:32 PM
Well, neither you nor Josh came right out and said it, but I think this is the key: There needs to be a public option bill written and scored by the CBO.
Until a bill is written, all the arguments are about vague concepts and lovely words. Which is fine, for a while.
One critical aspect of the Healthy Americans Act is that it's actual legislation, not a set of principles, not a concept paper, but actual legislation.
Once the public option is actual legislation, it can be CBO-scored. And once it's scored, we'll see how well it controls costs and how much money it will take to finance it.
Wyden's plan isn't perfect - I'm not sure any plan can ever be, since they always involve tradeoffs - but one major thing in its favor is that it's cost-neutral. We don't have to raise taxes or cut spending somewhere else to fund it.
Now, reasonable people can disagree about whether the cost-neutrality will ever come to pass - but the fact is that the CBO scoring is the only analysis that matters here. It's the single yardstick against which all plans will be evaluated.
I'm glad to see that Senator Wyden is open to the public option - and I'm glad to see that he's waiting until there's actual legislation that's been scored before signing on to a vague concept that means many different things to many different people.
[Full disclosure: my firm built Senator Wyden's campaign website, but I speak only for myself.]
Posted by: Gene Berk | Jun 13, 2009 12:05:34 AM
Wyden's proposed legislation undercuts a strong public option by leaving implementation up to individual states. This undercuts the potential bargaining power of a strong national pool. Did Wyden wait for CBO analysis of a strong pulic option before writing a proposal that doesn't have a mandated national public option? I suggest that readers look at Wyden's major campaign contributors to decide if the money he has received from the insurance and healthcare industries has influenced how he has stood on this issue. Go to: www.opensecrets.org/politicians/summary.php?cid=N00007724&cycle=2010
Posted by: Gene Berk | Jun 13, 2009 12:19:00 AM
Sorry,
Google this:
Ron Wyden: Campaign Finance/Money - Summary - Career | OpenSecrets
Posted by: torridjoe | Jun 13, 2009 1:12:34 AM
"Some of the health reform proposals floating around today would capture the uninsured by massively expanding Medicaid. Medicaid patients receive, on the whole, fewer choices, and poor access to health care when compared to those who qualify for Medicare and those who have private insurance. A great many doctors will not accept new Medicaid patients, if they take any Medicaid patients at all."
That's kind of a disingenuous analysis IMO, because part of the problem is that Medicare can't compete right now despite lower overhead than private providers, and the reimbursement rates are pathetically low in most places...but where the rates are good (such as in Florida as I understand it) the system does much better.
And frankly it's a canard--and kind of a sad one coming from a Democrat--to attack Medicare as inefficient and marked by poor care, when that's really not the case, particularly as I said with respect to their superbly low overhead.
Part of the weight behind an expansion or replication of Medicare is that it would be a competitive system that bargains to purchase care and is worth the time for doctors to treat people under the plan.
It's all well and good to talk about needing a "good" public option, but the bottom line is that for-profit medicine will always rely on the denial of care to maximize those profits. It's the actuarialism of health, and that's wrong--not to mention a guarantee of bad quality outcomes to medically treat people using that logic. Trying to come up with cost containment and access fixes while maintaining employer-based care and the ability of the market to set the terms of that care, is working hard and not smart. Why? Because a public option has natural cost saving incentives and essentially by design solves the problem of access.
As for CBO scoring--there are other analyses out there; it doesn't have to be a vague mystery which concept is superior. Here's the Lewin Group's, and one of the reports from the Commonwealth Fund. Both project annual cost savings in double-digit percentages.
Posted by: Josh Kardon | Jun 13, 2009 6:55:46 AM
First, I want to thank BlueOregon for again covering the issue of health reform and Senator Wyden's role in that effort. I will try to respond to some of your comments as the day progresses.
I'll start with Carla. Carla wonders what is meant by "sustainable" financing, one-half of the two-part test Ron will have for the financing of this proposal. The other is "responsible" financing.
They may look a little redundant, but they are not. For instance, Congress could choose to impose new taxes to pay for health reform. The "responsible" portion of the test would consist of a cost-benefit analysis and a look at whether the tax is fair (regressive or progressive, punitive, etc.). Sustainability refers to whether the financing chosen is likely to fall short, thus relying on future Congresses (which may not have a Democratic majority) to maintain the program, or plunging the country into deeper debt.
Posted by: Josh Kardon | Jun 13, 2009 7:17:05 AM
Gene, you are using too blunt of a weapon for this particular attack. If you search Opensecrets.org and look at the leading proponents of a national public option in the U.S. Senate (Kennedy, Dodd, and Schumer) you will see that they all have taken far more money from the insurance industry than Senator Wyden. They, like Senator Wyden, are good men, trying to work their way through difficult issues with independence, and without regard to campaign considerations. Further, you and others conveniently ignore the fact that AHIP, the trade association for health insurers, has attacked the Wyden health proposal since 2007 and are employing their stable of lobbyists to see that its insurance reforms never gain enactment.
Posted by: Josh Kardon | Jun 13, 2009 7:35:51 AM
TorridJoe, please show me where I attacked "Medicare as inefficient and marked by poor care." I did nothing of the sort. I pointed out the painfully obvious differences in health care access between the poor (many covered by Medicaid) and everyone else, which you chose not to address in your usual slinging of terms like "disingenuous," "canard," and "sad." If you would care to address my actual thesis, that (relatively) wealthy people get better access to health care than those on Medicaid, I would be happy to respond.
I challenge you to take the list of Portland's top doctors (Portland Monthly) and call each, telling them you are a Medicaid patient and want to get an appointment. See how that works out for you.
Senator Wyden wants to end the painfully obvious inequity that exists in the American health care system today. It is a caste system, it's immoral, and it should end. Everyone, even the destitute, should be able to sit shoulder-to-shoulder with CEO's and their member of Congress in the doctor's waiting room.
Posted by: phastphil | Jun 13, 2009 8:48:31 AM
From the Daily Howler's commentary on so called rational arguments on health care:
"As a result, very few of us rational animals really see how odd the state of play is.
We spend twice as Canada does—and we can’t afford what they have! These frameworks appear in this morning’s papers, fed to us rational folk."
Posted by: No More | Jun 13, 2009 9:52:05 AM
Gene, you are using too blunt of a weapon for this particular attack. If you search Opensecrets.org and look at the leading proponents of a national public option in the U.S. Senate (Kennedy, Dodd, and Schumer) you will see that they all have taken far more money from the insurance industry than Senator Wyden.
No Josh, it is not too blunt a weapon despite your best effort to try to deceive us. The contempt you and Ron exude for us and our intelligence with this kind of statement is so palpable that one has to wonder if there is even the remotest shadow of human decency left in you or Ron's soul.
First, we don't yet know whether the "Public Option" Kennedy, Dodd, and Schumer support is will look like genuine publicly-owned option administered administrative agency --- e.g. equivalent to Medicare --- and therefore truly indistinguishable from Medicare. Of if it will actually be a system where the government is a collection agent for private insurance companies in managed competition system. --- e.g. like the FEHBPP. I know that because I've had conversations with all of those offices in the last 48 hours, as well as the offices of a couple of House members whose name have been in the news. They confirmed that in fact there is not yet any definition of what a public option really is in any legislation --- and Democrats who favor forcing us to buy private health insurance are now doing everything they can to try to use that term to label any scheme they can come up with that looks like the latter. So trying to say Ron is no different than these guys isn't saying anything.
Second, what does matters is the PROPORTION of a Senator like Wyden's campaign contribution that comes from various corporate sectors and how that is reflected in their legislative record. Wyden's record on health care is clear, no matter how you and he try to backpedal and outright lie: He is far out of step with the actual wishes of Oregonians on health care. His agenda has been smugly and unapologetically to keep the insurance industry between us and our doctors AND to force us by law to do business with them. Lately, we've just seen him try to misrepresent his record (and Oregonians have seen right through it) and now we see him and you further trying to deceive and spin about a "sustainability" argument a passive aggressive way.
We the people are past excuses and spin. We are smart enough to see through empty politicians like Wyden and pathetic, venal staff puppets like you Josh. We don't want the health insurance industry between us and our doctors anymore.
A properly done single-payer system that rewards doctors for doing patient focused medicine that treats the whole patient rather than rewarding specialists who don't collaborate with other specialists, and providers who make their money on excessive testing as our private insurance system and corporate providers who treat patients as billable units is the most sustainable system in our economic and constitutional system. A genuine public option which has those critical features of a single payer system is the choice we want to have if a bunch of corrupted Democrats insist on working for the interests of private insurance companies by not giving us a single-payer system AND require us to buy health insurance as you and Ron do.
It's up to you and Ron to quit your spinning and get on board to give us either a well-designed single payer system or the choice of genuine, well-designed public option. Otherwise, we need and will elect a real Democrat in the 2010 primary who will do that. We have no interest in re-electing an arrogant, spinning, politician who up until now had been out there smugly thumbing his nose at those who brought him to the dance that is working with Republicans to give them and the private health insurance industry what they want.
Posted by: No More | Jun 13, 2009 11:04:11 AM
I challenge you to take the list of Portland's top doctors (Portland Monthly) and call each, telling them you are a Medicaid patient and want to get an appointment. See how that works out for you.
Josh, be real careful about the empty moral posturing you do: You have no clue what people who see through you may or may not know about our system in Oregon and how selfish careerist politicians like Wyden are responsible for what doesn't work here. I assure you that kind of arrogant attitude is helping all of us realize just why we need get behind dumping a Republican-chasing sellout like Wyden in the 2010 primary for a Democrat
I have had plenty of personal experience of trying to find Medicare and Medicaid doctors for family members. I have friends who are the working poor, some who are eligible for Medicaid and who either gotten no or minimal care and some who in a moral society would be. Our system here in Oregon, and my conversations with others in other states show we are not unremarkable in this regard, has been so rotted out by our private health insurance and corporate provider model that the system is all-but malpractice embodied.
In the case of Medicaid, almost as soon as we got the waivers in Oregon to set up OHP, we saw Democrats become complicit with Republicans at the state and national level in doing everything they can to make our Medicaid system in Oregon look like our private health insurance based system rather than a single-payer system in which Medicare and Medicaid patients would be indistinguishable and on top of that there would not be regional rate disparities.
We don't have to go into Ron's record as one, on the whole, of voting to open Medicare up to predation by the private insurance industry and being AWOL in the battle to reverse regional disparities that penalize states like Oregon. I think a more relevant political question is this: Does anyone remember Ron making fixing the problems with unequal Medicare reimbursements and the predations by Republicans an private industry a campaign issue? That's the root cause why new Medicare patients can't find doctors in Oregon. On the other hand, how many are quite aware how Ron thought he had a campaign issue deceiving Oregonians with empty phrases like "universal care" in his effort to distract from the reality of his industry-saving "reform" plan? That is, until we actually started to pay attention his plan was based on forcing us to buy private health insurance. And for those of us lucky enough to have employers who kick in some part of the cost for health insurance, taxing the supposed pay increase our employers would give us as he also forced them to discontinue that.
Not much more than two weeks ago Ron and Josh were still slamming the concept of a public option and single-payer. Then thinking we were too stupid to notice, they tried to trick people with the lie he was for it all along. Now their political tactic along with other Democrats is to remove any meaning from the term, AND adopt the Republican tactics of just trying to scare people with ominous statements of concern, in this case with vague concerns "sustainability" of this now meaningless cliche. This tactic of tricking people into pouring all their fears into an empty vessel labeled with a cliched term is at the heart of the moral bankruptcy of political leadership we have come to see in a lot of Democrats like Wyden and and most Republicans.
Ron Wyden has been worse than AWOL as the system has fallen apart here in Oregon, he has been complicit in making sure our entire system has become what it is with private insurance companies in charge and treating us as faceless numbers who exist only to pump money into their coffers.
Josh, maybe we need to challenge you and Ron to make a little wager: Maybe we sould should challenge him to agree to withdraw from the 2010 Democratic primary as the stakes in a single high profile public debate where he gets on stage, let's say in an arena-size venue, and debates the most informed health care advocates for single-payer and a public option nationally and in Oregon, and then have the audience vote whether he should withdraw. After all, you and he are asking us to put our health, livelihoods, and even lives up as our stake when we vote for him and his plan to give the Republicans, the private health insurance industry, and the faceless corporate health care industry (his donors) what they want.
Oh and by the way, I think there is a laughable how a political hack like Josh would with a straight face point to Oregon's local version of the empty popular entertainment press like "People/Us/We" as the place we should start our search for "top doctors". I personally prefer to look at the lists of alumni of top medical institutions that have a whole-patient, patient-centered, collaborative approach to medicine like the Mayo Clinic as the source for finding physicians who are competent and who even have the mindset we need to build a sustainable system. Funny thing about those doctors when I'm lucky enough to find them: They are for a single-payer or public option and don't think too highly of Senators who represent corporate America like Ron. The AMA membership who have a very different view is down to something less than 25% of eligible physicians.
Too bad Ron and Josh think we are dumb enough to believe their propaganda it's a matter of just re-arranging the corporate deck chairs a little bit by holding us upside down by our ankles, shaking our pockets out into the hands of the greedy private insurance industry, and leaving it up to bureaucrats at the top to somehow manage competition.
Posted by: Josh Kardon | Jun 13, 2009 11:05:06 AM
"No More," I don't think you are in a place to lecture anyone about deceit while you hide behind a nom de guerre.
Anonymous cheap shot jerks like you frequently make online comment forums a place where most people don't want to come, let alone participate.
If you disagree with the senator on health care, that is your right. If you want to vote for his opponent, that is also your right. But I fail to see how making BlueOregon's comment forum a place where most elected officials and their staffs don't want to come is in this community's, or the public's, interest.
Posted by: No More | Jun 13, 2009 11:21:35 AM
"No More," I don't think you are in a place to lecture anyone about deceit while you hide behind a nom de guerre.
Look you unAmerican little pissant. Why don't you review the Supreme Court decisions on the value of anonymity in legitimate political debate and then get back to us on deceit and moral integrity?
We know you're a pathetic little smug political whore who can't answer informed opponents and instead try to spin and deceive the less informed.
BlueOregon's comment forum a place where most elected officials and their staffs don't want to come is in this community's, or the public's, interest.
Ah, so we see the truth. From the standpoint of politlcal hack trash like you, the public's interest is not served by blowing holes in your BS, but instead just giving you a platform to spin and deceive unchallenged? Wait I think we know where that is: Fox News.
If whiners like you and Ron who first and foremost are out to force us to become revenue source for the private insurance industry can't take the heat you don't belong in politics. Get out of the way for leaders who have the personal integrity and the backbone, and who want to do the right thing. I don't see a Bernie Sanders or a Russ Feingold bellyaching about their views being exposed for hypocrisy, of course that's in part because they have the competence and the moral compass to actually do the right thing more often than not.
Carla and Kari, Kari in particular for you who works for you, may have wanted to give you the opportunity to spin a bit more. Informed critics came to the party. I think we see exactly why you and Wyden hide from the public and become surly at those few opportunities like town hall meetings where people show up to actual hold you publicly accountable.
Posted by: torridjoe | Jun 13, 2009 11:33:45 AM
I challenge you to take the list of Portland's top doctors (Portland Monthly) and call each, telling them you are a Medicaid patient and want to get an appointment. See how that works out for you.
When did the concept of reimbursement rates become static and frozen, completely unmodifiable? What's your point? That's why the call for reform--to improve access, to reduce costs and to improve care by changing the models of delivery.
What continues to be a disingenuous, sad canard is the continued dancing around simply admitting that Wyden's plan does not offer what an overwhelming majority of Americans want--a robust public option--by intentially conflating it with "single-payer" and denigrating public programs such as you do here. Wyden's plan creates no public option and maintains the employer-based, private-delivery model that cannot be sustained.
Posted by: Josh Kardon | Jun 13, 2009 12:20:41 PM
How in heaven's name did I miss the extraordinary value you bringing to American political discourse, No More? Yes, there you are - Daniel Ellsberg, Martin Luther King, Patrick Henry, Susan B. Anthony, No More. My bad.
TJ, again, If you would care to address my actual thesis, that (relatively) wealthy people get better access to health care than those on Medicaid, I would be happy to then respond to your next attack.
Again, Senator Wyden wants to end the painfully obvious inequity that exists in the American health care system today. It is a caste system, it's immoral, and it should end. Everyone, even the destitute, should be able to sit shoulder-to-shoulder with CEO's and their member of Congress in the doctor's waiting room.
Posted by: Josh Kardon | Jun 13, 2009 12:24:40 PM
TJ, you repeatedly argue that Senator Wyden is failing to act on alleged polling data about what Oregonians want. Setting aside for the moment the validity of your polling data and the actual questions asked and not asked, I wasn't aware that Senator Wyden was elected to simply read the polls and vote and act accordingly.
If Senator Wyden had followed your proposed course and simply followed the polling data, he would have 1) voted to authorize the war in Iraq, 2) voted for the Bush tax cut package, 3) voted to prevent gays and lesbians from being allowed to marry - to name just a few. Certainly, some members of Congress are inveterate poll readers. Ron is not one of them, however.
Posted by: rw | Jun 13, 2009 1:34:24 PM
Whoops, one more: No MOre, I WORK in this arena. Josh and company are right. Sorry, but I worked on the inside in direct interstice with clinic and medicaid disbursement panel, a very large entity covering all of Oregon and much of Washington. THey are right - medicaid slots are rationed. And the absolute venom visited upon the bureaucratic process I had to oversee was all about the fact tha "welfare does not pay us". I now sit in the private sector, overseeing these same things, and the courtesies availed me clearly are still not about me: they are all about the good money my entity pays them, so buying politesse for my day to day contacts.
In short: I was ranted at, refused, threatened and intimidated when working on the medicaid side. I worked every day to turn that around, to use my personality and knowledge, and willingness in every interaction to carve out respect and relationships with them that somehow overcame the intense venom reserved for "WELFARE"; now, here in the private sector seat, I am accorded courtesies I cannot ascribe to me as such a wonderful person. I know it is correlate ONLY to the fact that our contracts pay nicely. They need us even if what I oversee, well, they'd be happier wtihout me!
I worked on the inside as the medicaid rolls were closed and then the services offered carved up substantially more. You have GOT to be out of your mind to even imagine that our nation's poor, Oregon's indigent and working poor, are receiving adequate, much less nominally equal access and care. They. Are. Not.
Now, to balance what is essentially diatribe: when I fell on hard times, yes, I experienced the occassional doctor's office that took money they were not supposed to make me pay, and never gave it back once I found it out (that equalled the bus far to six interviews, people); I also occassionally was not treated with much beyond basic courtesy. They were not behaving as if they were focused upon becoming my medical home and BEING my medical home once I was successful again. HOWEVER, this was notable lapse. I would hazard to guess that these so-called doctors are the minority. Most of them cannot help themselves, this profession is a calling, and when you are seated before them, in need, they assert themselves to be of aid. I do not hate doctors and their peers. But I am not blind to the US intensity of hatred and disdain for the poor. LIkewise, the fact that we have forgotten that it used to be accepted that people's fortunes rose and fell, and it was no shame to fall on hard times and build one's life again. Before they are all gone, go talk to an oldster - they will tell you about that. The Depression, et al.
Posted by: No More | Jun 13, 2009 2:04:49 PM
Whoops, one more: No MOre, I WORK in this arena. Josh and company are right. Sorry, but I worked on the inside in direct interstice with clinic and medicaid disbursement panel, a very large entity covering all of Oregon and much of Washington. THey are right - medicaid slots are rationed.
Look rw, get the point right: What I clearly said was that Medicaid and Medicare are broken system BECAUSE, despite Josh's frantic spinning, the system we have right now is a result of what pols like Wyden who are defending the insurance industry and abetting in the predation of that industry on those public programs and us.
Whatever you might have done in your job, you clearly didn't know how in this state our "public plans", including OHP in most of the state, are essentially just purchasing agents for private insurance --- not health care --- which is pretty much what Wyden wants to do nationally in his billl where he abolishes the Medicaid system. You're crazier than a March hare if you think the industry and pols like Wyden, and their arrogant, dissembling flaks like Josh, who have and continue to fight for the private health insurance industry aren't responsible for that, or that their plan actually intends to actually keep the worst feature of that system: Putting insurance companies between you and your doctors, would change that fundamental corruption of our health care system.
If you think insurance companies are arguing with doctors out of the best interest of their patients, you are even crazier. On top of that it would be illegal for insurance companies to actually put insured interests against their business interests and there is absolutely nothing in Wyden's bill that would change that fundamental fiduciary obligation that has both legal and constitutional foundations. So please, you don't know who really is on your side when it comes to making sure your personal health care is in your best interest, and who really is to blame for what happened to you.
And Kari, I don't think "revenue neutral" is a relevant criteria at all for evaluating the quality of a health care plan: Quality of outcomes are. We've had a little taste in this state of what Ron Wyden would create with how our programs for assisting low income people are really to assist them to buy private insurance with all that contributes to poor health care outcomes. You were schooled by none other than Thom Hartmann a couple of weeks ago when you tried to defend Wyden, and frankly, you no longer a credible person or commentator because you have failed to learn from that.
Posted by: torridjoe | Jun 13, 2009 2:12:25 PM
If Senator Wyden had followed your proposed course and simply followed the polling data, he would have 1) voted to authorize the war in Iraq, 2) voted for the Bush tax cut package, 3) voted to prevent gays and lesbians from being allowed to marry - to name just a few. Certainly, some members of Congress are inveterate poll readers. Ron is not one of them, however.
This would only be a relevant argument if in fact what the public apparently favored so dramatically, was something that the Senator honestly believed would be bad for the country. Certainly the list of examples cited are considered bad things by the Democratic caucus. You can see the value in ignoring your constituency in those cases, because Senator Wyden has generally stated (and I think you mean to intend) his opposition to all of those principles.
...which makes comparison to a robust public option a curious one, suggesting that maybe the Senator doesn't in fact support it (something that's certainly been said about him in media accounts of Congressional positioning). If Senator Wyden AGREES such an option is a valuable and good thing as he wants us to believe, what's the payoff in ignoring a constituency that highly favors it? Why bother constructing a system that specifically excludes it instead?
Trying the "we're not poll-driven" dodge is used for refusing to do things you oppose, that the public is essentially "wrong" to want. I think your use of it is illuminating.
Posted by: No More | Jun 13, 2009 2:22:44 PM
How in heaven's name did I miss the extraordinary value you bringing to American political discourse, No More? Yes, there you are - Daniel Ellsberg, Martin Luther King, Patrick Henry, Susan B. Anthony, No More. My bad.
Josh, you're a fundamentally arrogant, ignorant, dishonest disgrace to the people of Oregon. In case you are too stupid, rather than just plain dishonest, what you have done here is a classic example of the fallacy of "Hasty Generalization", by pointing to a couple of examples that are not representative, not even relevant to the point, and then tried to deceive people with a false generalization that doesn't address the point.
Moreover,, with that trademark childish NW cynicism that is a pathetic attempt to hide ignorance and low character, you also have commited the fallacy of "Red Herring", by not addressing point of the long history of Supereme Court precedent endorsing the important role of anonymous political speech. I would refer people most recently to McIntyre vs. Ohio Elections Commission. If people want to actually learn something about anonymity and political speech, they could start here:
Anonymity
http://www.eff.org/issues/anonymity
Frainkly, given how Josh and Ron have shown themselves to be untruthful, arrogant, misleading, dismissive, unwilling to answer informed criticism of their claims and Ron's plan, and generally not trustworthy, why would anybody at this point give any regard for anything they have to say? And why, in the name of God, would anybody trust any plan these kind of people offer while being dishonest in answer their informed critics, to protect their own health, their livelihoods, and maybe even their life, as well as the health of their family and friends?
Posted by: rw | Jun 13, 2009 2:43:41 PM
No More: you and the others who think taxing to put revenue directly into hands other than the ones who "earned" it would certainly not like to have NO purchasing agent between the poor and their services. So you are saying you are all for allotting sufficient funds, freely, into the hands of hte poor so that they too may purchase?
You are a nut.
I work now on behalf of many small clinics who cannot win good rates on their own, and so they join this aggregate so as to add themselves to thousands of others, enabling us to negotiate reasonable rates for them. The same applies to solo purchasers of health care. I am not ignorant to the middle man status, dork. I worked in it. However, if you throw folks without resources, connections or private insurance out on their own to fare alone, they will NOT receive a baseline of benefit and access.
Could you please tell me if there is a system anywhere on the planet that does not employ some version of the aggregator/middle man? I don't know that it exists.
You are bonkers.
Quite.
Posted by: rw | Jun 13, 2009 2:45:27 PM
oops, to finish the thought: "you who think taxing etc.... is evil, wicked, wrong, would surely also blame someone else for the complete breakdown that would occur should you throw users out to try singly to access a certain level of care">... it's like, No More, no matter what we do, so long as you and yours do not have to proportionately, if not equally support - you are fine.
Posted by: rw | Jun 13, 2009 2:51:38 PM
No More is an idjit.
I am an old school public health worker. I know this dynamic inside and out from nearly every angle.
I heard a great lecture that brought me to tears last night. The CIty Club typically stultifies me. It's them talking to them's own.
Last night, Donna Beagle spoke, and it was refreshing to hear this PhD who speaks well, doubtless blends perfectly in Corporate Drag - telling the real story on her life.
And it reminded me of myself.
I'm not accomplished nor will I ever, possibly, accomodate the talent and potential hidden here. Too lazy, too self-pitying, too self-indulgent AND too many years without requisite resource in a telescoping economy! However, I should laugh each time I'm assailed by such as No More, as I'm one of the ones who has actually lived it from the pit to the palisade, and never been fooled when I got up where the air is perfumed. I never lose sight of the rest of reality.
So I guess I should follow the most recent prophetic advice of the Hopi Elders: "This is not the time to take yourself seriously."
No More kinda went off the deep end, but it was a great elucidation of the fucking mess our health system is in. Read the New Yorker six weeks ago - comparing McAllen TX to other states, clear research on out of control costs, more care = less effective care, etc. It was scary to read as someone scared of care rationing. But I could not argue with it.
Posted by: No More | Jun 13, 2009 2:55:16 PM
Let's also once and for all directly discredit the moral disgrace Josh's attempt to sound like he and Ron are champions of the people and have the moral high ground:
His claim is that by somehow making everybody have private insurance, rather than a single payer system, or a genuine public option that an overwhelming majority of people select, that low income people will suddenly gain the respect and services they deserve from medical providers and society. He offers that in a false attempt (actually a type of "strawman argument") to discredit single payer and public plan advocates. That is he throws up Medicaid as example, mainly to invoke fear, confusion, and doubt.
The reality is that we have a discriminatory system precisely because we have a system in which the priviliged have private insurance and others don't: In other words a system that puts a stigma on public insurance plans. Of course, it's even worse in Oregon where we have turned even our public plans over to the predations of the market.
Now there are two ways to change that. The first is to simply turn everything over to a system of private insurance with all we have seen that entails bad in our political system and for health care. Supposedly all discrimination will be erased because we have completely corrupted our system and everybody is a victim of that corrupted system. In that system our effort and resources will be devoted to managing competition and trying to curb the excess greed of private insurers with the attendant effect on patient outcomes.
The other is to do the right thing and create a patient-focused single-payer system which is accountable to the people, or at least a genuine public plan which has all those key features of a single payer plan. Discrimination disappears as an issue in that system because everybody's doctors, or at least those of the overwhelming majority, are paid by the same payer. Not much business sense for a provider to discriminate between patients when the payer for all or most says that won't be tolerated. We can then focus on fixing what's broken medically in our system and build a patient-focused, outcomes-based system.
Not only do you not have a valid argument Josh, you are defending a system which in fact by design puts private business interests ahead of us and our health because of where it will require us to devote our effort and resources to keep the system functioning. For most people it comes down to this:
Do you like Josh and Ron's idea where your health care battle will be personal battles with insurance companies for the rest of your life on top of health crises, and with advocates having to waste their time and talent to try to curb the excesses of the private insurance industry (and the politicians they support who kept control of our government)?
Or do you want a system where your main battles, god forbid, will only be together with your doctors against health crises, and together with advocates who want to improve our medical care system?
Which of those futures do you really want for your children, your parents, your spouses? What do you seen in Josh's behavior here and Ron's plan and behavior that gives you any justifiable belief that they actually share your values and the future you would choose?
Posted by: Josh Kardon | Jun 13, 2009 3:38:58 PM
I will shortly head off to catch some great music, so have at it, guys. TJ knows I cannot outlast him, and his is, by tradition and necessity, the last word.
rw - If I'm not mistaken, you are someone who has, from time to time, strenuously disagreed with Senator Wyden. I thank you for adding your perspective. First and foremost, we need to put everyone on a truly level playing field when it comes to health care. That used to be considered radical socialism.
TJ - First, you have your facts wrong -the Democratic caucus in the US Senate voted to authorize the war and ban gay marriage in rather significant numbers. I am not suggesting that they made their decisions on the polling, but will point out that the polling nationally and in Oregon pre-vote showed that people supported the war resolution at the time. And of course, you know where the American public and Oregon is generally on gay marriage.
Second - I raise the poll example solely because you repeatedly (here and elsewhere) post statements like "what an overwhelming majority of Americans want." We will see what Americans want once they see the options on the congressional table and better understand what they mean for their families.
Third - You consistently present Ron's openness to a national public option as opposition, as if it's a "you're either for us or agin' us" proposition. Thankfully, most of the country expects members of Congress to analyze and deliberate a bit before fundamentally altering one-fifth of the economy. Ron will continue to be open to a national public option, and support a state public option, as the committees begin to add some flesh to the bones of their proposals.
And now, a closing message for No More.
Most single-payer supporters are passionate, thoughtful, and responsible advocates. Ron has talked to hundreds of single payer supporters at hundreds of town halls, and has learned a great deal from them. While neither the House nor the Senate committee leaders have any intention of attempting to move a single payer bill, in my opinion, they should have invited single payer advocates to play a more prominent role in the discussions on Capitol Hill to see if progressives of all stripes could make common cause on a issues of mutual importance.
Unfortunately, a small minority of single payer supporters (like yourself, No More) gave the rest a bad name and that was horribly unfair.
Carla, this post's reporter, recently asked me to respond to a statement made by Gov. Dean at Earl's health reform presentation. I thought it was a pretty good question, though she really should have posed it to you:
"Gov Dean said that those who are showing up at town halls in support of single-payer are in some cases being deliberately disruptive. He bemoaned that they don't seem to be interested in dialogue, which is counterproductive."
Thank you, again, BlueOregon, for covering the health reform debate and inviting me to participate.
Posted by: rw | Jun 13, 2009 4:08:05 PM
Hi Josh - actually, I do not argue with politicos. I have no idea what Wyden's stance is. I'm just thinking about the issues, directly, as I experience them in the outreach, Regulatory and advocacy (as well as consumer!) positions I've taken from a variety of angles in teh field. I've consulted, designed programs within and without the programs, I've worked on the threadbare non profit side as well as the for profit side. I am lazy, so I do not research specific people.
I spoze I should practice sound citizenship and research Wyden if he is the most aggressive mover right now. I'm the guy who commits political suicide at the table.
:)... in fact, I've been asked to speak to the outsourcing to Hindi sweatshops of certain Regulatory functions, pushed now by UHC, Ingenix, Regence... hahah PacificSource personnel wanted to see what _I_ write on the subject. My wonderful boss leaned on my office door and said humorously, "Do I look suicidal?" to me. I appreciated her deft guidance and for once in my life am keeping my mouth shut.
No big dog gonna get his teeth in my leg, at least for this round.
Posted by: rw | Jun 13, 2009 4:14:21 PM
Josh - are you on the clock when you make those posts? Honestly.
Posted by: Carla Axtman | Jun 13, 2009 5:04:33 PM
Let's also once and for all directly discredit the moral disgrace Josh's attempt to sound like he and Ron are champions of the people and have the moral high ground
So you want to compel me that your argument is correct by acting like a jackass? You may or may not be right on policy, but this kind of pretentious garbage makes me want to quit reading your comment from the outset.
Frankly, I think RW may have you pegged, based on her analysis. She has a wealth of work experience in the field and has been an advocate in the health care system. And she's not behaving like a pretentious bully.
If you've got an argument to make on policy, make it. But cut the other crap.
Posted by: Carla Axtman | Jun 13, 2009 5:06:40 PM
This would only be a relevant argument if in fact what the public apparently favored so dramatically, was something that the Senator honestly believed would be bad for the country. Certainly the list of examples cited are considered bad things by the Democratic caucus. You can see the value in ignoring your constituency in those cases, because Senator Wyden has generally stated (and I think you mean to intend) his opposition to all of those principles.
No, that's wrong.
You either expect people to govern by polls or you don't. If you're going to cite them as proof that the Senator is out of step and should be forming policy that way, then it's the full boat.
Frankly, I think the public option is a necessity and Senator Wyden should step up and become an advocate. But I can't for the life of me figure out how being petty with his COS will get me there.
And I don't see how it will get you there either.
Posted by: Josh Kardon | Jun 13, 2009 6:08:31 PM
rw - I'm always on the clock. I was contacted in my office on Friday and asked to respond to questions from Carla on behalf of BlueOregon.
Posted by: rw | Jun 13, 2009 6:38:34 PM
Hey Josh - just asking. It feels to me that occassionally you as a plain old guy begins to peep through, but then it is back to pure politics. I worked in your range during the Viagra Wars. I know a little tiny bit about your turf. And, sadly, since you are bought and paid for, it's hard to have a dialog with you. It's just your job. You are a likeable guy - not a blistering ideologue like the assholes I encountered in Ashcroft's office. So I don't fault you. But I hate it that talking with you is simply politics.
Posted by: rw | Jun 13, 2009 7:22:38 PM
... and yet, it is nice to perhaps be able to log my voice directly into the offices of a man who makes and breaks the lives of those I witness, reach out to and try to help when I can. And if I can have a chance to share my own perspectives reasonably, and maybe even have them represented to carve out more balance, then I'm for it. I kid you not, I was the sole online pharma person who got through to the GAO and managed to enlighten to them to this one cadre I worked with, who were not mere outland pirates seeking millions. They were nerds and geeks actually pioneering and developing shipping, logistics and online privacy and confidentiality applications... there really was much more to some of it than the activist attorneys generals wanted known. Just so, I would wish that my lone, politically suicidal voice might also break through... like a dab of red smeared into Kandinsky's "Garden of Love" - breaking through in all its ludicrous and necessary splendor.
Posted by: Adam | Jun 13, 2009 7:41:27 PM
Josh, Thanks for coming here and putting up with pompous, self righteous, arrogant, ignorant, idiots like No More. You mainstain your composure a lot better than I would.
I just can't stand the breathtaking arrogance and hubris of No Nore. As if someone apponted him with the unique abilty to know exactly what the pubic wants and what is best for the country. And then to assume that if someone has a point of view that differs with his, then it must be because of corruption. This is all to typical of the wing nuts on both the left and the right.
Please, have some humility. Consider for a moment that maybe you don't really speak on behalf of a majority of Americans or Oregonians. Consider that maybe you don't have a monopoly on the truth and what is right and good. Consider that maybe someone else might have more or better information than you, or might be smarter than you. Consider for a moment that maybe it is possible for someone to have a different point of view and opinion, yet not be corrupt.
It is people and attitudes like No More that make me want to avoid involvement in politics, even though I have a great passion for public policy.
Posted by: No More | Jun 13, 2009 8:10:29 PM
No More: you and the others who think taxing to put revenue directly into hands other than the ones who "earned" it would certainly not like to have NO purchasing agent between the poor and their services.
What are you even trying to say here rw? Wyden is advocating for pretty much the opposite of what some of what you say you believe in:
a) Wyden says everyone should, by law, be required to purchase their own private insurance. That means a healthy percent of some of each individuals and the nation's health care dollars go to other than health care. He is advocating welfare for the insurance industry, plain and simple.
b) Those of us who are for single-payer or a genuine public plan are advocating everyone buy their coverage, either through a premium system or a tax, from one single "insurer" which would not only have more purchasing power than any single insurance company or the industry as a whole, but also every dollar beyond administrative costs (much lower administrative costs than the industry) would go into health care. That is, we are arguing for the largest single/aggregator possible that would have the most possible market power to buy health care services and control costs: All of us acting as a body through the health care administration of our government. Like Medicare is. So when you state in your obvious confusion:
Could you please tell me if there is a system anywhere on the planet that does not employ some version of the aggregator/middle man? I don't know that it exists.
I am in fact arguing exactly the opposite. Whatever is rattling around in your head, how you possibly could get from that So you are saying you are all for allotting sufficient funds, freely, into the hands of the poor so that they too may purchase??
Furthermore, you claim you work now on behalf of many small clinics who cannot win good rates on their own, and so they join this aggregate so as to add themselves to thousands of others, enabling us to negotiate reasonable rates for them. (Health care) clinics are providers of services. Are you saying you work on behalf of health care clinics negotiating higher rates for their health care services with insurance companies? Or are you saying you are buying insurance products to pay for health care services for some entity or group of people?
If you work on behalf of clinics that are health care providers (as defined quite clearly in HR-676) negotiating higher rates with insurance companies for the health care services you provide, the whole point of a single payer or large public plan is to eliminate the parasitic private health insurance industry in the middle to reduce net costs to all of us as health care consumers and to improve the net revenue picture of responsible private providers. And most especially to improve the net revenue picture of small and independent providers. It is a system that does this by streamline the administrative costs of billing, equalizing payments to providers, and to the extent possible encouraging patient-focused collaboration between providers. It reverses our current system that is inherently fragmented by the very existence of the parasitic private health insurance industry that sucks dollars out of the system purely to sustain it's own existence.
If you work to buy insurance products, a single payer system or a properly designed public plan would make you part of a larger buying pool then you are now and give you market power far beyond anything you try to communicate here.
So exactly what are you trying to do here? Your comment about the poor actually could be taken as suspiciously and simultaneously inappropriately paternalistic and maternalistic. You certainly don't present a clear thesis and a connected argument that supports that thesis. You're all over the map refuting arguments you claim I'm making that are 180 degrees opposite of what I'm arguing. You actually sound a little off your rocker.
Now to Josh, who thinks once again he can claim the moral high ground with this juvenile, slithering comment:
Most single-payer supporters are passionate, thoughtful, and responsible advocates. Ron has talked to hundreds of single payer supporters at hundreds of town halls, and has learned a great deal from them. While neither the House nor the Senate committee leaders have any intention of attempting to move a single payer bill, in my opinion, they should have invited single payer advocates to play a more prominent role in the discussions on Capitol Hill to see if progressives of all stripes could make common cause on a issues of mutual importance.
Unfortunately, a small minority of single payer supporters (like yourself, No More) gave the rest a bad name and that was horribly unfair.
Josh, you're nothing more than an empty DC spin-artist whose tactic when confronted with your deceit and arrogance is to fall back whining and play to the crowd that you are the "victim". No you and Ron have and continue to be supporters in his plan of an industry that is a predator on the American public. There is no reason we should be diverting a dime of money that should go to health care to the private health insurance industry, much less requiring people to pay tribute to that industry, including levying taxes on any income their employers may chose to give them to pay that tribute. All of our health care dollars should go to buy health care services and the lowest cost, high volume administrative services we can get from the MACs the CMS uses to administer claims processing. Your attempt to supposedly drive a wedge between those who stand up up to your repeated deceit right in this thread and the rest of those whose values on health care they share shows you have nothing.
I think you know the people get it: So far you and Ron in your support for the private health insurance industry don't stand for the future they want for themselves and their future. So all you can do is whine when you are exposed for the fraud that you are.
Let's also once and for all directly discredit the moral disgrace Josh's attempt to sound like he and Ron are champions of the people and have the moral high ground
So you want to compel me that your argument is correct by acting like a jackass? You may or may not be right on policy, but this kind of pretentious garbage makes me want to quit reading your comment from the outset.
The public is already convinced what they want, that's why Ron and Josh are running as scared as we've seen a politician and his CoS run in Oregon in a long time. Why Carla could possibly believe it is relevant for her to interject her ego into this and make this about what she thinks about other people really is between her and her therapist.
And by the way Josh:
You have your facts wrong -the Democratic caucus in the US Senate voted to authorize the war and ban gay marriage in rather significant numbers.
Why don't you provide us that list, I think it would be instructive to compare those who voted that way with those who share Ron's position supporting the private health insurance industry and against single-payer or a genuine public plan that puts us first.
Posted by: Gene Berk | Jun 13, 2009 8:26:03 PM
Josh,
Let's be precise. The following are figures from Open Secret.
For Senator Wyden:
The top 4 contributors to his 2003-2008 Leadership PAC are:
1. Harsh Investment Properties
2. Pacific Crest Securities
3. Pape Group
4. Blue Cross/Blue Shield
The top 5 industries contributing to his 2003-2008 Leadership PAC are:
1. Real Estate
2. Hospital/Nursing Homes
3. Retired
4. Insurance
5. Securities and Investment
For Senator Kennedy:
The top 5 contributors to his 2003-2008 Leadership PAC are:
1. Simmons and Cooper L.L.C.
2. National Education Association
3. Communication Workers of America
4. American Federation of Teachers
5. American Federation of State County and Municipal Employees
The top 5 industries contributing to his 2003-2008 Leadership PAC are:
1. Lawyers and Law Firms
2. Retired
3. Public Sector Unions
4. Building Trade Unions
5. Industrial Unions
As one can see there is not a single individual contributor to Senator Kennedy's top 5 list of individual contributors to his 2003-2008 Leadership PAC from the insurance or hospital/nursing home industry and neither of theses industries(insurance and hospital/nursing homes) show up on his list of the top 5 industries contributing to his 2003-2008 Leadership PAC. Yet we see a different story with Senator Wyden's top contributors. Senator Wyden's 4th largest individual contributor to his 2003-2008 Leadership PAC is Blue Cross/Blue Shield and Hospital/Nursing Homes rank 2nd among the top 5 industries contributing to his 2003-2008 Leadership PAC and insurance ranks 4th on that same list.
If you were to look at these lists of top contributors to Senators Wyden and Kennedy without knowing to whom the lists belonged what would you deduce about each senator's position on a strong public option?
Posted by: No More | Jun 13, 2009 8:27:04 PM
Please, have some humility. Consider for a moment that maybe you don't really speak on behalf of a majority of Americans or Oregonians. Consider that maybe you don't have a monopoly on the truth and what is right and good. Consider that maybe someone else might have more or better information than you, or might be smarter than you. Consider for a moment that maybe it is possible for someone to have a different point of view and opinion, yet not be corrupt.
Adam knock off childish whining and junior high level psychology. The arguments were made refuting assertions Josh had made on the substance. Josh has dodged and weaved every one of them trying to play to babies like you instead. He and Ron are nothing more than politicians whose first goal is to keep their jobs by playing ball with those who have contributed to their campaigns. Check the link someone else provided above.
You may have a great passion for public policy, along with the detached sense of entitlement people should listen to you. But no one owes it to you to coddle whiners like you. Politics is hardball. Health care is a matter of life and death. The private health insurance industry Ron is trying to continue to has harmed people and will continue to harm people under Ron's corrupt little plan. There is an outcry like we haven't seen for a generation from the public that has politicians like Ron and Josh running scared because they know they are on the wrong side of the public's feelings and all they have now is their attempt to get the upper hand back by sowing fear, undertainty, and doubt.
You don't have anything of value to offer anybody if you think sitting there and whining when people dismantle the arguments of opponents and point to the callowness of their record is somehow not behaving in a way that encourages you to contribute whatever precious turd it is you think you have to contribute.
Posted by: carla axtman | Jun 13, 2009 8:31:13 PM
You don't have anything of value to offer anybody if you think sitting there and whining when people dismantle the arguments of opponents and point to the callowness of their record is somehow not behaving in a way that encourages you to contribute whatever precious turd it is you think you have to contribute.
If only we had a mirror.
Posted by: rw | Jun 13, 2009 8:38:17 PM
At last, No More utters cogently.
NM, I actually flinched when I heard, on the run, the proposal that everyone should be coerced to purchase insurance (in South America this is how it goes) - yet on the other end of it, the poor and small businesses would be excepted. So: no net change. My son, working for a small business, will continue to fear the day we have to figure out how to get a high four figures of cash in hand to take care of the oncoming wisdom teeth.
You assume, NM, that I stand with WYden. You rant at me alarmingly. Let's be clear: I would die of utter morbid boredom to work as an insurance agent. Yech. However, I am the one who helps tiny clinics and solo providers stave off the day they are FORCED into corporate, large clinics as the only way to make it go and get reasonable rates from the insurance panels.
I feel medical providers have a sickening entitlement mindset. They are the worst of the wealthy in one side. And then, they are Called to their craft in a way that arrests my heart. I can disrespect their status hierarchy manners, their sense they are OWED hundreds of thousands of personal earnings AFTER overhead, annually while still loving their marvelously cerebral craft and the fact that they too follow a Calling. I've been mated to a medico, been in their midst and also worked with them in many different settings and roles. I am qualified to speak from this perspective I have gained. :)...
At any rate, NM, I am with you, but you are so busy attacking and carrying on, you eschew a conversation that leads to this understanding.
More's the pity.
Posted by: rw | Jun 13, 2009 8:42:24 PM
By the way, NM, although I just hate the way you rant and bitch and carp, I do like the fact that tasty words are showing up. Sometimes it feels like you are laboring to put them in, but, hell, people who are jealous of MY vocabulary try to think the same of me even when I'm not doing it. So I'll choose to believe that words like "callow". Too bad it is buried in diatribe just about fitting a high school senior just before the ball is hiked. You are simply talking trash to the line men on the other side.
Posted by: carla axtman | Jun 13, 2009 9:18:35 PM
You may have a great passion for public policy, along with the detached sense of entitlement people should listen to you. But no one owes it to you to coddle whiners like you. Politics is hardball. Health care is a matter of life and death. The private health insurance industry Ron is trying to continue to has harmed people and will continue to harm people under Ron's corrupt little plan.
You seriously believe that private insurance is going away any time soon..?
Even if we get a public option, private insurance will still be a part of it. Dean specifically mentioned that in the interview I had with him...and he's a vocal advocate for this reform.
Dean told me that places which already have single-payer programs in place don't do so without other, private options as well.
What silly invective.
Posted by: Kari Chisholm | Jun 13, 2009 9:48:14 PM
Well, after a lovely day of touring Yamhill County in search of some of the best wines that our state has to offer the world, it's a little jarring to come back to the vitriolic stupidity in the comments in this post.
I don't have any problem with anyone speaking truth to power, asking hard questions, or even "blowing holes in BS"... in fact, doing those things is a service to democracy.
However, behaving like a jerk, calling people names, and throwing tantrums is neither a service to democracy nor welcome in this space.
The behavior in the comment threads is starting to look more like pro wrestling (with all of the attendant posturing and belligerence) than thoughtful conversation around a water cooler.
We're just about ready to roll out a new commenting system that should put an end to all this -- or at least, ensure that people own their words.
Anonymity in political discourse can be valuable. It can also be damaging. I've long defended our practice of allowing anonymous comments. With the rising tide of anonymous vitriol - some of it by professional monkey-wrenchers - and the rise of the conversational web (via Twitter and related tools), it's no longer critical that we allow anonymous commentary in this space.
Stay tuned.
Posted by: No More | Jun 13, 2009 9:57:14 PM
You assume, NM, that I stand with WYden. You rant at me alarmingly. Let's be clear:
No RW, I didn't assume anything. That's why I asked you to articulate whatever thesis you wanted to advance clearly.
You seriously believe that private insurance is going away any time soon..?
Even if we get a public option, private insurance will still be a part of it.
Never said anything of the sort Carla. In fact what I think the smart thinkers about single payer and a genuine public option say is that the private insurance industry can offer all the bells and whistles they want to those who want to spend their money (a la HR-676). If we have a genuine public option, the industry is dis-empowered overnight and will increasingly find itself in the same position of trying to make it selling botique add-ons as single payer advocates describe. That's completely different from the whip hand Wyden wants the industry to still have.
And just to illustrate that I can criticize PNHP as not having a much more credible argument at times than single-payer opponents: Himmelstein's and Woolhandler's criticism of public plan advocates is based on the same game of attacking some amorphous cliche of of a public plan that the anti-single-payer folks attack. also make the completely nonsensical argument that if 95% of the people joined a public plan, we would not achieve the significant savings single-payer could achieve. This argument is idiotic on it's face:
First, if the public plan were based on using the MACs just like CMS providers first would realize enormous savings providing care for that 95%.
Second, as business people who can and right now refuse to accept patients whose insurance poses unacceptable business costs, why would those providers all of a sudden change and bear unacceptable business costs providing care for that 5%?
Right now, we don't require doctors to accept Medicare or Medicaid business because that would be interfering in the market. If we instead have a plan which removes the unfair barriers to public insurance that actually exist so that the market can decide, are those pols going to now try to claim that we have to interfere in the market and force doctors to accept those remaining 5% of patients who chose a private health insurance plan that puts undue administration costs on doctors and who would continue to have a selfish hand interfering in the doctor-patient relationship?
One of the biggest frauds the Democratic and Republican pols doing the private health insurances work keep repeating is how the industry faces "unfair" competition while in fact a public plan would really unstack the deck which is now stacked completely in favor of the industry (including an anti-trust exemption right now and a mandate to buy private insurance if Wyden gets his way) and in fact introduce the kind of competition we the people need and want.
I want to go back to this smarmy comment from Josh:
Unfortunately, a small minority of single payer supporters (like yourself, No More) gave the rest a bad name and that was horribly unfair.
I wonder Josh what you think of those doctors and nurses who were arrested for standing up twice to Baucus and the rest of the majority Democrats in the committee of which Wyden is a member who determine the witness list? Baucus made smart ass remarks in the same spirit as yours, while Wyden smugly sat by and failed to do anything showing he had any respect for them, much less actually arguing they should have a seat at the table. Once again, Josh, the record is clear and no amount of pompous "victimhood" can mask the stink.
Posted by: rw | Jun 13, 2009 10:33:12 PM
Ummmm Kari? [repentent, foot-scraping] Sorry. Did not mean to surrender to my worst parts again. I think I rather lost my head after, somewhere, Carla said something to the tune of "See old AR-Dub over there? She actually has been feet on the ground all over this part of the land, AND she ain't being a bitch".... off I went over the falls in a barrel of puffed up happiness.
Ack.
Sorry folks.
Posted by: Kari Chisholm | Jun 13, 2009 11:39:11 PM
RW, you're fine. It's that other person on this thread.
Posted by: rw | Jun 14, 2009 12:05:29 AM
Giggling wildly.
"That other person."... By Chisholm, from BO.
"He Who Shall Not Be Named."... Voldemort, Harry Potter.
"If you can't say something nice, say nothing at all"... Everybody's Grandmother.
"Bless his hearrrrrt, he's just a meeessssss"... The Ladies in Oklahoma, with a soft and steely half-smile.
Ack.
:)...
k.
Posted by: rw | Jun 14, 2009 12:05:30 AM
Giggling wildly.
"That other person."... By Chisholm, from BO.
"He Who Shall Not Be Named."... Voldemort, Harry Potter.
"If you can't say something nice, say nothing at all"... Everybody's Grandmother.
"Bless his hearrrrrt, he's just a meeessssss"... The Ladies in Oklahoma, with a soft and steely half-smile.
Ack.
:)...
k.
Posted by: No More | Jun 14, 2009 10:34:15 AM
However, behaving like a jerk, calling people names, and throwing tantrums is neither a service to democracy nor welcome in this space.
When a political figure like Josh comes here to engage in political posturing, which is his job and quite apart from personal debate, he has been treated completely consistent with the norms of his purpose. He doesn't get to fall back on dishonest tactic he's just another average person adding an opinion here because he is here to do a job and to win support for his boss pretty much anyway he can. The fact is Carla, and you more so Kari, are also in the business of political spin (you're paid to do it and your disclaimers don't buy you a pass) and are only due a different quality of response. You don't like that and in fact, you are fundamentally dishonest in that you try to blur that distinction with comments such as those above to try to sway people to buy your argument.
Furthermore, every comment I make starts with a quote clearly delimiting what I am responding to and the comment responds to that: Some comments others have made purport to be factual, to advance a position, or sometimes are in fact a character attack. You and Carla are particularly guilty of the latter. Your sniping character attacks generally take the form of paraphrasing or taking a quote out of context and not addressing that, but instead trying to make a play to the crowd you are their champion because you too are a victim. When in fact it is only you, Carla, or Josh who is actually being criticized for the quality of your comment and the character you demonstrate in the political opinion spinning role you came here to do.
rw - it's unfortunate that you apparently misunderstood what I was saying. I thought you might have been saying something different than I thought you were saying with your first comment that I quoted to not unfairly paraphrase you in the first comment above (Posted by: No More | Jun 13, 2009 2:04:49 PM) where you addressed me. I certainly think you add some interesting spice to the conversation and I suspect we could be much more on the same side of the issue than it might seem.
We should note these two comments by Josh just to make sure we all understand the deceit in Kari's comment (and why my exchange with rw was of a very different character, as well as the efforts I think were shown on both sides in that case to clarify what clearly was more of a miscommunication):
Posted by: Josh Kardon | Jun 13, 2009 11:05:06 AM
If you disagree with the senator on health care, that is your right. If you want to vote for his opponent, that is also your right. But I fail to see how making BlueOregon's comment forum a place where most elected officials and their staffs don't want to come is in this community's, or the public's, interest.
Posted by: Josh Kardon | Jun 13, 2009 6:08:31 PM
rw - I'm always on the clock. I was contacted in my office on Friday and asked to respond to questions from Carla on behalf of BlueOregon.
Politicians go anywhere there is a community of people they can talk into giving them their votes, honestly or dishonestly. What is important here is what Josh's whining, and Kari's and Carla's, says about their dishonesty in admitting they can make their political pitch rather than actually be held to account for the content of that political pitch.
(Adam is another sad case who also criticizes based on not being honest about Josh, Carla, and Kari's actual purpose here: He basically just whines in that self-entitled way we have come to see to much in our society that people seem to confuse their opinions with their egos and respect with egoism. Opinions are due pretty much the respect the quality of thinking and values those opinions demonstrate. Adam is very disrespectful in not recognizing that and criticizing those who don't bow to egoism but in fact rebut the poor quality of opinions.)
Thom Hartmann schooled you the other week on Wyden and health care and it is not rude or uncivil to recount what happened there and note the insight that gives into you and your comments here: You came on defending a politician and a political position (Wyden). You were rebutted on the facts and Thom and Carl actually ended up defending Merkley to you, the guy you also champion as your job --- it's just defending Wyden was your mission that day not your other client. The low quality of your thinking and the values you demonstrate were exposed and discredited. You then tried switch the social dynamic to regain the political upper hand by falling back on what is called the "bandwagon" fallacy (appeal to a friendly crowd) in argumentation that is was just good we were to the point we were talking about health care at all. No it's not good people are just talking because some people like you, Ron, and Josh have values and political objectives that you want the outcomes to embody and the rest of us do not share some of those goals and values.
Posted by: No More | Jun 14, 2009 10:40:21 AM
We're just about ready to roll out a new commenting system that should put an end to all this -- or at least, ensure that people own their words.
From an argument standpoint, Kari's threat about "people owning their words" are of course another "bandwagon" argument. Political actors like Kari, Carla, and Josh know how the social dynamic of that is to narrow the political argument to those who share their views. And of course, that is their intent. They are entitled to do that, but their attempt to claim the moral upper-hand is in fact quite the opposite of the under-handed goal and effect.
For those who want a little more dispassionate information about the role of what is called "reputation" in online communities from the standpoint of a venture like BO, here's a link to a Yahoo Developer Network note on what is called online "Reputation"
Note specifically the second item in the first column "Identifying Labels". Some of you may find it surprising just how formulaic (you might note it's called a "Design Pattern") the methods are that website owners use to build support for their venture amongst the visitors the sell to their customers (Some might call it benignly manipulative.) You shouldn't be. Blue Oregon is a venture just like businesses are, and ventures draw on the best they can find in the psychology and marketing research to influence people to benefit the venture.
And of course that what you are here: Visitors whose numbers the proprietor needs to retain and hopefully increase to build the venture. It doesn't matter whether it's not-for-profit or for-profit, the goal is success of the venture and of course note those ads above which contribute to the success of the venture. But political debate is just a bit different than Facebook groups, and Kari's "ownership of words" threat has a very different relevance. Hopefully, sharing that Yahoo link and the information therein will make you a little more informed, and therefore less susceptible to manipulation, as you decide what you features you choose to value in online political social communities and that will redound to the benefit of us all.
(Torridjoe, it bears noting whenever a competitor attempts to change the formula that got them to where they are, it presents the risk they may screw it up and the opportunity for a competitor to benefit from that. One is led to wonder if you stepped back and thought a little strategically, perhaps talking with others you might know in the your blogging circle about tactics Loaded Orygun or a successor might take to benefit from any missteps by Kari, political debate in Oregon might benefit enormously ;). BO seems to be increasingly burdened down with plodding thinkers who are mainly interested in holding on to whatever minimal online reputation they have managed to build here. )
Posted by: Kari Chisholm | Jun 14, 2009 10:44:10 AM
Blah, blah, blah....
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Posted by: Adam | Jun 12, 2009 8:20:04 PM
"Senator Wyden is choosing however to highlight and champion portability, reining in health care costs, and raising everyone's health care to the level currently enjoyed by every member of Congress."
I think these are the right priorities. I'm less concerned about the ideological battle between those that want to avoid "single payer" at any cost, and those who want "single payer" at any cost.
We need to sever the link between employment and health care. It's dragging down wages and labor mobility, hurting the entire economy and hurting our international competitiveness. Where you work or whether you work or not should not have any impact on what kind of health insurance you have, and you shouldn't have to change insurance or pay extra or anything if you lose your job.