Is a weak public plan option better than none?

Chris Lowe

This is the second of two related open threads on aspects of public plan options in health care reform. The premise of this one is that we are facing a choice between a weak public plan or none at all, and to ask if even a weak public plan is worth fighting for, if it doesn't matter, or if a weak public plan might be worse than none. If you'd like to argue that actually strong public plan ideas remain on the table, please do that over at the other thread.

On Wednesday, President Obama said that he wants to be the president who brings about the health care reform that ends the struggle that began with Theodore Roosevelt in 1912. While he might eventually be that president, pretty clearly it won't happen in this session of Congress, even if Obama does get a public plan option from Congress. Getting a public plan, however, looks decreasingly likely.

Saturday morning on the radio, the NPRniks were opining that Obama saying Wednesday that he could accept a bill without a public plan option meant that's probably what he'd get. That top House Democratic leaders Nancy Pelosi and Steny Hoyer likewise are backing off insistence on a public option lends credence to the NPR pundits' viewpoint.

Does it matter?

In the single payer circles where I'm active, there is a bit of a debate about what it would mean for future health care for there to be a weak public option in whatever reform occurs. Almost everyone agrees that none of the current proposals will resolve the fundamental crises of the system, and that they are so acute that we will be debating reform again before long.

Beyond that, some people think doesn't matter it there is a public plan or not. They say the public plans now mooted would function exactly like private ones because they've been designed that way.

Other people think even a weak public plan would be better than none. The basic point related to public provision of health care access is that it would create a toehold with which to work. A second layer of such argument is that it's important not to reward the campaign of lies that has been mounted against the president and any reform, and to defend the idea of taking public action for the public good.

Then, to the contrary, some argue that a weak public option would be worse than none. The reasoning goes like this: The whole reform package, with or without a weak public plan, will not resolve the crisis. In particular, it won't resolve the rapid rise of health insurance premiums for skimpier and skimpier policies, even if "coverage" does get closer to universal after 2013. This round of reform will come to be seen as a failure, and if it contains a useless public option, that fact will be adduced against any other form of publicly provided insurance or social insurance. Better not to have one so that the absence of public provision will make clear that the crisis remains the failure of private insurance and a system that treats health care as a commodity.

Each of these arguments could be made in the context of supporting a strong public option as well as that of supporting an improved and expanded Medicare for all single payer system, where I've encountered them.

What do you think? Is a weak public plan worth fighting for?

Comments

  • evil is evil (unverified)
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    Absolutely not. Single payer is the only plan. In fact, I don't like single payer if it does not take in dental coverage, abortions, or eye glasses prescriptions. I think that other than total coverage of everyone, including anyone who is in the usa, is obscene.

    Better to have a huge number of pissed off people than to just let enough in to kick the rest in the teeth.

    37th in the world in life expectancy while spending the most in the world for "health care." Yeah, yeah usa.

    Sorry, I'm a little ticked off. I just went through wired.com "hottest links" #12 where there are 82 photos of signs that accidentally picked up a lot of people at the demonstration in washington, dc. One minority race person out of the hundreds around the signs.

    Absolutely sickening. Devastatingly revealing of the whole subculture that is the white racists.

  • Bill R. (unverified)
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    It's important to have some plan. There are too many people that can't wait for your kind of perfection. One of them is a family member with life threatening cancer, who if she survives, has no chance of ever being insured again without change, survival, I might add, a survival that is likely to be accompanied by a financial bankruptcy. If there is something in place that approaches access for all, at least we have created a new expectation that there needs to be medical care for all. Some plan can be built on, or thrown over for single payer, but some plan must be passed, or we just sink deeper into the despair that we have now.

  • zull (unverified)
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    I read the speech, and maybe I came away with something different about the "5%" thing, but it read and sounded to me that he was saying that the analysis was that only 5% of the public would even have to resort to the public option anyway.

    I read that as "don't worry about it, it's not as big a deal as you're making it out to be...but if it works, hey, that's great". The marketplace notion sounded more to me like an attempt to placate Republicans...we all know that the insurance companies are going to pricefix there as much as they do everywhere else.

  • Anon (unverified)
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    With the watered down version of the public plan being sold by the media and - it seems fair to say - by Obama during his speech, where few people will even be eligible for it, the answer is it's worse than nothing. Regardless of the arguments for and against a non public public option, the fact remains that most of us will be fish in a barrel where the insurance giants have us legally required to buy insurance and where they have no restraints whatsoever on how much they charge and on how insultingly skimpy they can make the package.

    If you consider Obama's speech stirring, take a recording of it to the hospital with you when you next fall critically ill and need fortune draining resources just for your room.

  • Anon (unverified)
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    If we don't take a stand, and say at some point in all of this, that simply filling the pockets of the insurance giants is not good enough, then there never will be a public option and there probably never will be decent health care in the time left to this tottering experiment called democracy.

    Just wait and see how the insurance companies clobber and twist the rules until they have us right back where we started and where the howling appetite for fear and hatred washes over any "second chance" like a tidal wave.

    We have compromised away anything meaningful over and over and over, with every sort of core value of our civilization, from habeas corpus to our own government spying on us to torturing and causing the death of people who never had a chance to even argue their innocence. Do you really think this time, with insurance giants salivating at the meal they are about to be served, the outcome will be different?

  • RyanLeo (unverified)
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    A strong public option that would usher in a single payer system would require a: 1. Economic Depression and 2. Collapse of the current healthcare system. Currently, none of those two conditions are present and trying to paint a 'perceived' crisis based on some egghead's estimates ain't going to change reality.

    Reality is, for any public option you need 60 votes in the US Senate to override a filibuster. I highly doubt Senator Baucus, Senator Conrad and many other Democrats from rural midwest and southern states like voting yes on a plan that may potentiallyend their political career.

    Preferably, I would prefer a weak public option with a sunset and a weak funding line. I do not want another golden cow that furthers this entitlement mentality where people expect something for nothing...or more than they put in.

    As a 25 year-old, I don't expect to and resent those who retire with a publicly funded public employees pension that gives them close to $60k/year regardless of whether they put in 5, 20 or 40 years to get it. Likewise, I do not expect Medicare to be around once the Baby Boomers have gotten their fill from it.

  • LT (unverified)
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    We need something to pass this year which:

    Doesn't wait until 2013 to go into effect (not only do people need help now, but "vote for me the next 2 election cycles even though the health plan won't help you until 2013" is going to be a nonstarter.

    At least begins the discussion of changing from the fee-for-service model to doctors on salary who don't need to see patients every 8 minutes or whatever even though some consultantions should take longer than that, or encourage more tests because tests get reimbursed but talking to patients does not.

    Ends the problems of people being denied insurance, being dropped from insurance when they get sick, people going into bankruptcy over medical bills, and other current problems.

    As well as a way to train more health care workers and a lot of other issues.

    This is why I never signed on to WE MUST HAVE A PUBLIC OPTION as if signing on to a slogan solves everything.

  • Mrs M (unverified)
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    I voted for Obama and I am still glad I did. However, I now expect him to carry forward on his health reform campaign promises, and the "change" he described. Compromise with insurance companies and other profiteers to get "something" passed is not not good enough for me. It should not be good enough for you either.

  • Greg D. (unverified)
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    The whole point of a public option plan is to create an alternative for those who can't (or won't) pay Blue Cross prices for basic medical insurance. If the public option is not actually available to the public except under extreme circumstances, I don't see the point. Arguably a "weak" public option is the camel's nose under the tent for a future broad based public program, but I don't think it is worth the pain and political damage Obama and the Dems would need to suffer to create it.

  • Joe White (unverified)
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    How 'bout a plan that would allow individuals to band together to purchase group insurance and negotiate favorable rates like large corporations do?

    How 'bout if they can do this without governmental involvement and at no cost to the government?

    Explain to me why you wouldn't support (and why your Senators and Congressmen don't support) such a plan.

  • AdmiralNaismith (unverified)
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    @Ryan: Both North Dakota and Montana have majorities that support the public option. In fact, the only states that don't already have two Republican Senators. Only exception is Nebraska.

    Besides, not all Democratic Senators even have to vote for the bill. We only need 50 plus Biden to pass it. The only thing all 60 Democrats have to do is not filibuster their own bill.

    It is possible for a weak bill to be worse than no bill at all. It would encourage the Democrats to pat themselves on the back and consider the job completed. The weak plan would be more likely to fail in practice, and would be a LOT more likely to not solve problems that a strong public option would have solved...and then, of course, the Republicans would point to failure as evidence that the government solution always fails.

    At a minimum, without a strong public option, they cannot require mandatory purchase of private coverage. That would be moral and political death for anyone who tries to impose unfunded mandates on individuals.

  • LT (unverified)
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    "How 'bout a plan that would allow individuals to band together to purchase group insurance and negotiate favorable rates like large corporations do?

    How 'bout if they can do this without governmental involvement and at no cost to the government?"

    Explain the logistics of this and how it deals with rising medical costs.

    There are places in this country where doctors are on salary rather than doing fee-for-service medicine (Mayo Clinic is one).

    Cleveland Clinic not only has doctors on salary, they decided one way to cut medical costs was to provide free stop-smoking programs not just for their workers but eventually for everyone in their county.

    The models for this sort of thing are out there. Demanding a public option or worrying about government intervention in health care (why is it OK for an insurance bureaucrat to stand between doctors and patients, only wrong if the government does it?) don't solve these problems.

  • Hannalee (unverified)
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    A weak plan is worse than none. It could give some fuel in the future to people who think government shouldn't do anything as the Administration has argued. And it couldn't serve the function that people like me hope it will. At least a strong public option would give people an alternative to being forced to fatten the purses of those who have brought us to this. A public plan would be worthwhile for that reason alone. If things were to get even worse, I think people might gravitate toward the public plan. But who can say? It's all such a complicated mess. Who's to say what's going to happen, what unintended consequences could occur? Clearly, there's no actual reform without some kind of public plan. The only good thing about a bill without one is that it might hasten the crisis that is sure to come from a worse and worse health care situation in this country. And that might eventually start a revolt that would lead to true reform. The problem is all the suffering that will occur in the meantime. I say that as one of the likely sufferers...

  • RyanLeo (unverified)
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    Admiral Naismith,

    If what I am reading and hearing is correct, Republicans believe that a Public Option in any form will open up the flood way to a Government Health Plan that will corner the health insurance market and kill the health insurance industry. They argue that no private health insurance company can compete with a Government Health Plan that is user funded, funded by employer mandates and funded by annual Federal budget.

    As such, I do believe that if any public option is proposed in the US Senate, then Sessions, Cornyn, Coburn or some other Republican in a safe seat will filibuster it. Thus forth, you absolutely need 60 votes to call a point to order to have a vote on the bill.

    With Kent Conrad, Max Baucus, Robert Byrd and others, I do not see Reid able to garner the necessary 60 votes if a public option is proposed.

    Then again, that is what the US Senate is for. It is the more deliberative legislative body to counter-balance the political vicissitudes of the US political mood. Love it or hate it, in James Madison's words "ambition must be made to counteract ambition."

    Personally, I do not believe that this was not the most pressing domestic issue for Obama to tackle. I would have liked to see Obama reform the SEC to clear out the good ole boys, bring the Federal Reserve under the Secretary of Treasury's oversight, and aggressively go after the sky high, ludicrous CEO pay in the private sector.

    Then again, Obama is a dreamer and dreamers dream of golden cows.

  • (Show?)

    Joe, There is a consortium of small colleges in Oregon that "banded together" to form a larger group to get some additional negotiating power and the actuarial benefits that come with a larger risk pool. Forming such a pool is terrifically complex and in order to do it they had to hire a firm that specializes in managing health plans for employers. Even so the colleges still needed to have their own h.r. people tasked with running interference with the insurers and / or the management company.

    So, first thing, in practice, is that your idea would require a) insurance companies willing to sell insurance to "banded together" individuals such as you describe, and b) companies with the expertise in dealing with the massively inefficient private bureaucracies in insurance, hospitals and other providers such as group practices who would be willing to do the negotiating (actually probably also facilitate the individuals in finding one another to "band together.")

    So, let's assume that some people with such expertise think they can make money that way because the savings the individuals would realize would be greater than the new costs they'd have to pay to form the group, negotiate and have the plan administered. And let's assume they're right and various individuals see that they'd save a bit that way.

    Under the current set-up I have no objection to people doing those things if they want to, and I doubt there is any legal barrier to their doing so, apart from some limitations created by restriction of insurance to within states.

    But this would only help a limited number of people. You still are leaving out of the picture that in employer-based group plans, the employer generally covers something between 50%-100% of premium costs (a percentage that is declining as insurance costs rise much faster than inflation, productivity or wages).

    Paying the full freight even on group plans would be prohibitively expensive for most of the people who are uninsured.

    And, of course, this suggestion does nothing to address the problem of the secular rise in insurance prices even as the extent and quality of coverage declines.

  • (Show?)

    LT, In addition to the places you mention, Kaiser-Permanente operates on somewhat similar lines in our area. There are also some smaller practices that work on a partially prepaid model in order to reduce the pressures to see as many patients per day for as short a time as possible.

    As you note I think, these are issues to do with how care is delivered as opposed to how it is paid for. Are you involved with John Kitzhaber's Archimedes Movement at all? The question of what the content of care is and how it is delivered is central to that project, as you may know.

    However, I personally think Archimedes detaches the two issues more than is realistic. One of the reasons I support a single payer system is that it would make it much easier to create systematic incentives to shift away from fee-for-service payment models and to reward good outcomes based on health promotion, prevention, timely primary care, and early stage chronic disease management.

    In principle a strong public option could do something similar, or even a strong open "Exchange," though less systematically than a single payer system.

  • Adam503 (unverified)
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    Looks to me like Jane Hamsher at Fire Dog Lake isn't kidding around about holding House Dems to their pledge to not vote in favor of a bill that does not have a public option.

    http://campaignsilo.firedoglake.com/2009/09/08/michael-capuano-sam-farr-are-open-to-triggers-and-im-open-to-primaries-for-michael-capuano-sam-farr/

    http://campaignsilo.firedoglake.com/2009/09/08/grijalva-trigger-would-be-surrender/

    http://campaignsilo.firedoglake.com/2009/09/10/yes-obama-campaigned-on-a-public-option/

    If a House Dem made a promise to only vote for a bill with a public option, and back out of that promise, they're going to have a much harder time keeping their seat next election.

    Someone is FINALLY actually DOING something instead of just typing about it. Go Jane!

  • JR (unverified)
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    Everyone agrees that some reform to the system is needed...obviously tort reform and allowing people to purchase insurance across state lines are the best ways to decrease costs, increase competition while preserving the highest quality healthcare in the world. And before any of the single payer clowns point to their google search of the healthcare "rankings" and claim that the US does not have the best healthcare in the world..save your breath..everyone knows that if you are in need of medical attention, the US is the best place to receive it..if you disagree..feel free to head down to mexico the next time you get sick..i guarantee you won't do it..b/c the best medical treatment in the history of the planet is found here in the US, and you all know it...that is not something that is open for debate. As for the "public option", everyone also knows that the whole purpose of it is to ultimately run private insurance companies out of the market, as they could not compete with a gov't plan that is not bound by a bottom line...which would lead to a single payer, gov't run monopoly in which no competition at all exists. I realize there are some people (very confused, ignorant and misguided people) who advocate for a single payer system and that is why they so strongly want the public option to pass...but all serious people who want reform that will actually improve the system know that this is a monumentally horrendous idea. Some things are debatable..this is not..there is absolutely no viable argument to be made for a public option..and cloaking the argument for one in the false claim of "increased competition" does nothing but destroy any credibility that argument ever had. Obama is certainly the worst president I've seen in my lifetime, but if he pushes through a public option..he will firmly secure is place as the worst president in history....if you like the guy and, more importantly, if you care about America, you will stop pushing him to implement the single worst domestic agenda item we have seen in decades. Healthcare reform should not entail healthcare destruction, and if you can't understand that, you need to leave it to the adults to handle this, your voice is not needed or wanted in this debate.

  • Ron Morgan (unverified)
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    "How 'bout a plan that would allow individuals to band together to purchase group insurance and negotiate favorable rates like large corporations do?"

    People do that already, unions for instance. I'm not sure how this qualifies as reform since it occurs already, although it's difficult to achieve the economies of scale you're talking about without creating significant administrative infrastructure, which is sort of the opposite of a "band of individuals". In fact, it would probably have to be a corporation...

  • Anon (unverified)
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    Republicans were able to pass gigantic tax cuts for the rich without a 60 vote filibuster proof majority. They were able to declare war against a country that had nothing whatsoever to do with 9/11, never mind with weapons of mass destruction, without a filibuster proof majority. So why can't Democrats do the same thing with affordable health care that has some minimal guarantee of remaining affordable?

    Over 70% of the public is in favor of a strong public option. This comes from left, right and from the center of our political spectrum (don't let the propaganda machine called, "main stream media" fool you). So why can't we do it? Why can't the politicians in the Democratic Party do it? Because they are bought and paid for just like their Republican counterparts (ping and pong) by the insurance industry.

    The noise we are hearing about compromise is nothing but the demand that the public capitulate entirely to the desires and paranoia of corporate America. Why do we owe these Democrats in Congress and in the Senate our health and our lives? So that they can continue to be inundated with sleazy campaign contributions while they also receive government run healthcare benefits from government run hospitals?

  • Anon (unverified)
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    Tort reform takes away your right, as a United States Citizen, to challenge the medical industry in the event of mal practice that causes you serious harm. Clearly, everyone agrees, we have to eliminate this right if we are going to have serious health reform. Remember, you can't be free if you are free to take someone richer and more powerful than you to court. That's totally against the new American principals.

  • Jim (unverified)
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    Joe White wrote:

    "How 'bout a plan that would allow individuals to band together to purchase group insurance and negotiate favorable rates like large corporations do?

    How 'bout if they can do this without governmental involvement and at no cost to the government?

    Explain to me why you wouldn't support (and why your Senators and Congressmen don't support) such a plan."

    I am all for the plan in your first paragraph. It is called single payer health insurance. We live in a society with democratic institutions, and We the People are the government, and just like you, I support a plan allowing individuals to ban together. These individuals are all the folks in the country.

    This whole healthcare debate as well as the teabagger folks are really giving light to how lazy some people are. They live in a society where government is supposed to be their tool, but they will do nothing but complain about it when it doesn't work as they like instead of trying to do something about it beyond wave signs of Obama as Hitler; etc. No movement, no long term organizing, just whining.

  • genop (unverified)
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    A weak public option might be palatable if the only public aspect is a one-time subsidy to set up a single large non-profit entity to negotiate on behalf of members for lower cost, more efficient procedures and lower cost prescription plan allowing for acquisition overseas if necessary. Premiums must be competitively low. Coverage must include preventive (free) annual exams, and a low deductible. The premium should be based on making the option self sufficient so the subsidy applies only to initial set up and premiums kick in to eliminate the subsidy.

  • BOHICA (unverified)
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    Anon asked why?

    I think Bob Dylan said it best: "Money doesn't talk, it swears".

    Too, also ([TM] Sarah Palin), the MSM are nothing but a bunch of whores, afraid to actually report the details or call out the lies.

    Wasn't the Republican mantra on SCOTUS appointments "We want an up or down vote?"

  • AdmiralNaismith (unverified)
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    As such, I do believe that if any public option is proposed in the US Senate, then Sessions, Cornyn, Coburn or some other Republican in a safe seat will filibuster it. Thus forth, you absolutely need 60 votes to call a point to order to have a vote on the bill.

    I suppose that's different from what I said, for reasons you'll no doubt explain to me.

    The Senate ONLY needs the 60 votes to stop a filibuster. They need only 50 plus Biden to pass the actual bill. Therefore, a handful of blue dogs are free to vote against the actual bill without killing it.

    And as far as I can tell, worrying about the 60 votes to break a filibuster is a nonissue. NOBODY filibusters their own party's legislation. The last time it happened was in the civil rights era, back when the Southern racists were Democrats, before I was even born. It's hard to imagine even the mangiest blue dog daring to do such a thing in this day and age, and impossible to imagine said Democrat keeping it up for more than a week before capitulating under enormous pressure. Health insurance reform is life or death for the Democratic party for the foreseeable future--ESPECIALLY for the Democrats in red states (What, did you think that those Democrats elected there are chosen because the conservative voters approve of their abortion and gay marriage stances? When red states vote Democrat, it's pocketbook issues!). No Democrat smart enough to get to the US Senate is going to be willing to go down as THE Senator who killed his party just to appease the insurance conglomerates!

  • RyanLeo (unverified)
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    There ain't no use making phone calls to your US Congressman. All the Lucy in the Sky with Diamonds proposals are always presented in the House before they get moderated in the US Senate to the point where the original proposal is unrecognizable...at times.

    You better start making phone calls to your US Senator because that is where the fate of any healthcare reform will be decided.

    If Democrats propose a public option in the Senate version, here is what may happen:

    1. A Republican in a historically conservative, always safe seat (think Blumenauer's district except opposite ideologically and in the South) will filibuster the bill.

    2. Under Senate rules, to pass a cloture that ends debate on the bill beforehand, you need 3/5ths (60 votes) of the entire US Senate to end debate.

    3. With US Senators from traditionally rural and conservative states (i.e. Montana, North Dakota, West Virginia, etc.) they may not vote to pass cloture.

    I can see this happening if any public option is proposed. Republicans ever since their budget standoff with Clinton have shown a propensity for gutsy, unwavering maneuvers, while Democrats have shown a propensity to capitulate. Furthermore, a filibuster will make Obama look weak like Jimmy Carter, which is exactly how Republicans want to paint him.

  • RyanLeo (unverified)
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    Admiral Naismith,

    Senator Sessions, Senator Coburn, and Senator Cornyn are all Republicans. I never said that a Democrat would filibuster their own bill. I stated that they may not vote to end the filibuster from a Republican.

  • PNP (unverified)
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    Looks to me like Jane Hamsher at Fire Dog Lake isn't kidding around about holding House Dems to their pledge to not vote in favor of a bill that does not have a public option.

    That's exactly what we need to do, and I'll add a "strong" publicly-OWNED, publicly-accountable, publicly-managed option. Or just allowing us to buy into a Medicare Part E program.

    I voted for Obama and I am still glad I did. However, I now expect him to carry forward on his health reform campaign promises, and the "change" he described.

    Mrs. M is right.

    However it may be useful to quote his campaign website from February 2008 to remind ourselves how he used his considerable, but now failing, speaking skills to actually keep us misled about what he stood for throughout the campaign and even now.

    Here's the relevant text from his February 2008 website under the Issues->Health Care link:

    Obama's Plan to Cover Uninsured Americans: Obama will make available a new national health plan to all Americans, including the self-employed and small businesses, to buy affordable health coverage that is similar to the plan available to members of Congress. The Obama plan will have the following features: * Guaranteed eligibility. No American will be turned away from any insurance plan because of illness or pre-existing conditions. * Comprehensive benefits. The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have. The plan will cover all essential medical services, including preventive, maternity and mental health care. * Affordable premiums, co-pays and deductibles. * Subsidies. Individuals and families who do not qualify for Medicaid or SCHIP but still need financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan. * Simplified paperwork and reined in health costs. * Easy enrollment. The new public plan will be simple to enroll in and provide ready access to coverage. * Portability and choice. Participants in the new public plan and the National Health Insurance Exchange (see below) will be able to move from job to job without changing or jeopardizing their health care coverage. * Quality and efficiency. Participating insurance companies in the new public program will be required to report data to ensure that standards for quality, health information technology and administration are being met. National Health Insurance Exchange: The Obama plan will create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan ...

    Note how skillfully this is constructed to not avoid people thinking in a comprehensive way what he actually proposes. In the lead he refers to a "national health plan" that has similar BENEFITS to the private insurance-based FEHBP, but does refer at all to the ownership structure. In the rest of the bullet items except for the last one he refers to the "public plan" and continues to talk about benefits, but not ownership. Only In the last item where he does not talk about benefits does he talk about ownership. There he refers to the "public program" and not the "national health insurance plan" or the "public plan". With that last bullet item, it turns out his whole proposal is nothing more than a wasteful duplication of the National Health Insurance Exchange he lays out again in the next item.

    I talked to his health care point person way back in Summer 2008 who flatly refused to clarify whether in actual practice Obama supported a pubilicly-OWNED plan, or whether he was for an FEHBP privately-owned managed care system which is already an example of the Exchange concept, and that would suffers from much of the same cost-inflation incentives as the rest of the insurance market that the FEHBP does now. I think he was too arrogant to accept that a lot of us are out here are at least as smart as Obama and people he has brought around him, or at least when it comes to detecting political BS.

    For comparison here's the closest related text from his current website:

    IF YOU DON’T HAVE INSURANCE, THE OBAMA PLAN: * Creates a new insurance marketplace — the Exchange — that allows people without insurance and small businesses to compare plans and buy insurance at competitive prices. * Provides new tax credits to help people buy insurance. * Provides small businesses tax credits and affordable options for covering employees. * Offers a public health insurance option to provide the uninsured and those who can’t find affordable coverage with a real choice. * Immediately offers new, low-cost coverage through a national “high risk” pool to protect people with preexisting conditions from financial ruin until the new Exchange is created.

    Note how it is purposefully ambiguous what your choice is if your employer offers crappy insurance, how a "public health insurance option" differs from a "public plan", a "public program", and a "publicly-OWNED, publicly-accountable, publicly-managed plan/option". And in his plan Obama doesn't articulate any mechanism by which costs would actually be controlled. To get the benefits in a purely private health insurance based system as he seems to describe in his February 2008 version means not controlling costs since the market forces required to do that aren't present.

    Most developed countries have a national health insurance system because the politicians have the fear in their heart that only comes from knowing the people will vote them out of power if they don't make sure such a system exists. FDL has it right and that's what we need to be doing.

    BTW - Anybody else notice that from both of Obama's position, by rights Joe White ought to be his biggest fan. They pretty much want most of the same things including keeping the private insurance industry in control. All Obama is calling for is one extra private insurance option and calling it a public plan. So Joe White, you need to be going to www.barackobama.com and kicking in a few bucks to make sure the man stays right there with you.

  • TruBlue (unverified)
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    We cannot allow tort reform to become part of any compromise package on health care. That's the real repuglican agenda here. If we cave on tort reform, we will lose millions and millions in contributions from trial lawyers across the nation...and we can't afford to lose that, especially going into a mid-term election cycle. This is bare-knuckle time, and it's all about our bottom line as a party!!!

  • PNP (unverified)
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    Everything "TruBlu' says is exactly right. Especially since it has been shown repeatedly that even the fear of malpractice is only contributing negligibly to out-of-control rising costs in our health care system.

    Chris --- here's a key question about "weak public options" that Obama and some Democrats are now arguing we should have. Would insurance companies have a basis in Constitutional law to challenge regulations which simultaneously set benefits and prices and restrict market access for companies that do not conform to benefit and price regulations? I'm no lawyer, but I know Constitutional lawyers who tell me it's a serious question. If they do the fatal flaw (deceit!) in even Obama's plan is that it actually cannot control prices, since I don't think we can compromise minimum benefits to achieve price controls.

    The marketplace difference between a true publicly-owned, publicly-accountable Medicare Part E (Medicare Part A and Medicare Part B) plan and what they are proposing is that the with Medicare Part E consumers would be a single buying bloc in the market and the downward market pressure that would keep on provider prices is clearly constitutional. And in fact providers right now see insurance companies as the enemy every bit as much as consumers do, so at a minimum they have emotional incentives to push their prices up in Obama's weak public program model that don't exist with a strong publicly-owned plan.

    This is exactly the problem with the OHP. For the most part, all the OHP does is enter the market to buy private insurance at a slight discount (after overhead markup is added back on top of the purchase price discount). The discounted purchase price in reality just tracks the unregulated, rapidly rising price index between insurers and providers. There is no countervailing downward buyer pressure on that price index.

    I think you have started an interesting and important thread in this debate. And I think you could really take it in an important direction, and hopefully draw out some lawyers, be addressing that key question of whether the Obama-corporate Democratic plan could meet constitutional muster if they simultaneously regulated services and prices and access to the market. Remember, after Congress passes a plan and the President signs it, the insurance industry has recourse to the courts and the bucks to fight it out there. And even Sotomayer clearly lines up on the corporate end of the "corporations --- people" axis in her legal experience and rulings. Given that, we should be under no illusions who any plan that they don't challenge in the courts favors.

    You might even get Joe White constructively engaged in the conversation in a way we could start to talk about what we have in common rather than in opposition. It's the Joe Whites of the world we have to has this out with, getting past the bad feelings, and focus on how the working person is the one who always gets screwed by the corporations and the government if we don't band together.

    Joe --- as a publicly-owned plan advocate, and a supporter of the power of the market to set fair prices our economy can actually bear, I am vehemently opposed to a command economy/health insurance market in which the government would simultaneously regulate benefits, prices, and market access, and enforce a mandate through the IRS that we have to purchase insurance in that market. I see that as a complete affront to any legitimate notion of liberty and democracy. And I'll bet there are far more grassroots Democrats who would turn their wrath on politicians if they understood that is what happening than the right wing could possibly scare up. So how do you feel about that?

  • Emmit Goldman (unverified)
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    Re: "I do not expect Medicare to be around once the Baby Boomers have gotten their fill from it."

    That's why you need to support Medicare for All. RIGHT NOW, before the Obamascammers have muddied the waters even further.

    Re: "Anybody else notice that from both of Obama's position, by rights Joe White ought to be his biggest fan. They pretty much want most of the same things including keeping the private insurance industry in control."

    I've noticed. And I've also noticed that Obama's foreign policy is the same as McCain's (McCain: Obama Doing What I Would Do on Battlefields, http://blogs.abcnews.com/george/2009/08/mccain-obama-doing-what-i-would-do-on-battlefields.html).

    Of course, Obama is better than McCain would have been, except for foreign policy, privatizations, torture, coverups, kidnappings, health care, bailouts for the rich, civil rights, military spending, immunity of the powerful from prosecution, "free" trade agreements, corporatized education, union dis-empowerment, war crimes and crimes against humanity, secret negotiations with corporate elites, discrimination by faith-based grantees, and support for energy, mining, logging, ranching and food-production norms. Am I forgetting anything?

  • evil is evil (unverified)
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    The fastest, simplest and cheapest way to get single payer is to trade off President Obama for it.

    One representative files a bill of impeachment for war crimes committed under the Obama administration.

    This will pull all eyes to the left, who can then trade their votes for "We will vote for impeachment as soon as we get the single payer bill passed."

    The worst that happens is that Obama is impeached and tried for war crimes. Hey, it's his wars now. I don't care if he is impeached. All that cute lawyerly crap during the campaign that really didn't mean a commitment to anything but the status quo. I will give him stem cell research other than that he has done nada, zero, zilch that I personally wanted.

    So Joe Biden rises to the Presidency. Personally right now, I would regard that as an improvement and if he sees the boss impeached, he might get the idea of just how ticked off people are.

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    evil is evil and Emmit Goldman, I do hope you realize that you don't speak for the whole or even I venture to say a majority of the single payer movement in the character of your criticism of Obama.

  • RyanLeo (unverified)
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    Emmit Goldman,

    Supporting Medicare for ALL right now is equivalent to adding 300 more passengers to a sinking ship.

    I would just prefer that ship to sink below the waves enough until it is radically redesigned to be solvent for the next 3 generations after the Millennials.

    This current third party payer health insurance system whether it be through Kaiser Permanente, Medicaid, Medicare, Regence Blue Cross/Blue Shield and on, is equivalent to a 16 year old's car. Daddy (3rd party payer) paid for the car, pays for the car insurance, and pays for the car maintenance, while the only thing that the 16 year old (US health consumer) pays for is the gas.

    You see this in health insurance where an employer pays close to $800/month for a $1000/month individual health insurance policy leaving the individual employee to pick up the remaining $200 or so tab.

    This is our system that was instituted during World War 2 as fringe benefits due to the wage freezes. It has continued on because it is a huge tax benefit for businesses that can afford to purchase health for all their employees.

    I believe that if you use it, then you should pay for whole of it...with government tax credits, monopoly busting, and health insurance reforms to get individual health insurance costs down to an affordable level.

  • Joe Hill (unverified)
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    I am certainly for single payer, and all I hear from my friends (admittedly massive selection bias and certainly an echo chamber) is disappointment with Obama. We expected more.

    Even the question that heads this topic (is a crumb from a cookie better than nothing) is a tipoff. It's insulting, don't you think? (And no offense meant to you who have posted it, I recognize the good intentions and the tragic relevance.)

    I guess the answer to the question is: would a weak public option hasten or block true health care reform, by which I mean a single payer, take the profit out, system? I think the answer is it would help to block it.

    Therefore a crumb is worse than nothing. Vote it down. Stare Obama down. Crush the DLC once and for all and have it out with the corporate wing of the Democratic Party. If Max Baucus and the Blue Dogs want a bloodbath with their own people, let's get it on.

  • Greg D. (unverified)
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    So, if I am getting this right . . .

    God Bless Medicare and coverage for my mother. Perhaps it will still be there in a few years when my wife and I can participate.

    And screw everybody else.

  • PNP (unverified)
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    Supporting Medicare for ALL right now is equivalent to adding 300 more passengers to a sinking ship.

    Actually RyanLeo, this illustrates you don't actually understand Medicare For All.

    If you bring everybody into the system, that means you bring in all the currently healthy people. Their money that would go to over-priced private insurance would instead go into the Medicare system, and with the increased purchasing power, we would in fact get the upperhand to bend the cost curve on medical costs. All while providers remain private businesses and medical decisions remain between patients and providers.

    The only way to save Medicare, actually, is to bring everybody into the system.

    Another way to look at it is that if Medicare for All is not sustainable, any fragmented system based on the private health insurance industry with it's much higher net cost to our economy most definitely is not sustainable.

    evil is evil and Emmit Goldman, I do hope you realize that you don't speak for the whole or even I venture to say a majority of the single payer movement in the character of your criticism of Obama.

    That may be Chris, but how do you believe the single payer movement currently actually does view the hypocrisy of Obama and the Democratic majority right now? Certainly the conversations I've had with representatives of the mainline advocacy community for single payer, the ones who actually have operating budgets and paid staff, feel we are at a crossroads and they don't see Obama or much of the Democratic majority as being credible reformers. For exactly the reasons I've cited. Joe Hill is not too far off.

    I think the problem right now is that Obama and those Democrats are out-of-touch with what is actually happening on the ground. Emotions are evolving very quickly against that obvious disconnect.

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    Greg D.. I'm not sure what "this" is. There's an original post and a pretty varied bunch of comments. To what do you refer?

    Joe Hill, IMO it's a sad pass, brought about by a bad strategy that was bad in a number of ways, at least two of which were insults.

    One of those insults was the choice of the DP leaders and many reformer organizations to put single payer "off the table" and try to keep it out of discussion and testimony for reasons not related to substance but to "political realism," which was both patronizing and intellectually bankrupt, and, as many people pointed out, amounted to the public option focused reformers bargaining against themselves.

    By early June Howard Dean was saying here in Portland that it had been a strategic mistake by President Obama to let "robust public option" become the left pole of the debate. It isn't clear to me if Dean had argued against this within the HCAN/ Obama strategy discussions or if he was admitting error himself. I heard it reported in that passive voice formulation, "let it bome," not sure if that's an accurate quote, he was speaking to an overwhelmingly pro-Obama audienece of mostly DP insider activists, but the truth is that the exclusionary choice made "robust public option the left end of the spectrum for no good reason and gaining nothing, which is why it was bargaining against themselves.

    The second mistake that was also an insult is connected to the patronizing aspect of the first, which is that the strategists misunderstood or misdefined the politics to which they applied the idea of political realism, looking immediately to the question "what can we get through Congress," thereby short-circuiting the process of public education about various choices and arguments about them and related debate. The effect was to make it all inside baseball backroom politics, with ideas asserted or floated and shot down or agreed to in mysterious and arbitrary ways that inevitably engendered suspicion, and left much of the public open to stampeding by a campaign of lies and distortions, even while it left the backroom negotiators ungrounded in anything, acting on pure expediency with no anchoring constituency or ideas in the face of intense big money lobbying.

    The Tea Party Patriots and others they mobilized felt cut out of the debate, as indeed they were, but so was the rest of the public, and not just single payer advocates, but even supporters of variations on public plans, as well, most crucially, as those who know something is wrong but don't have well-defined views beyond that even now.

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    PNH, I lost an almost finished response to some of what you wrote a while ago in a depressing TypePad posting glitch. I will try again composing somewhere safer.

  • Joe White (unverified)
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    PNP wrote:

    "Their money that would go to over-priced private insurance would instead go into the Medicare system"

    Actually their money would go into the General Fund and be spent by the Democrats in congress, just like every other dollar for Medicare and Social Security has been mishandled since the inception of the programs.

    Government has never shown itself worthy of the trust needed for a program of this type. What makes you think they are now?

  • Bill R. (unverified)
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    The main problem in passing any bill with a public option is the Senate. The best and only chance for any kind of public option, strong or weak, is through the budget reconciliation process in the Senate with 50 plus votes in order to bypass the filibuster. So the pressure needs to be on the Blue Dog Dems who have yet to commit to a public option, Wyden, Baucus, Warner, Webb, Feinstein, Conrad, and the rest of them, enough to get 50 votes. Right now it looks like there are maybe 45 committed to the public option according to Open Left.

  • PNP (unverified)
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    Actually their money would go into the General Fund and be spent by the Democrats in congress, just like every other dollar for Medicare and Social Security has been mishandled since the inception of the programs.

    Unfortunately Joe White you are wrong on a number of points. You are a very factually uninformed person who needs to learn some humility because of that. Almost every claim you make is easily refuted by even the simplest research. If you were to recognize just how completely factually wrong most of claims are and how easy it is to prove you don't know what you are talking about, you might actually have a chance at becoming informed and developing some credibility. In the meantime, you are just making yourself the butt of humiliation, and it's saddening to see you do that to yourself.

    First, as a technical matter those funds would go into a separate account and anyone who cared could raise holy hell with Congress for misappropriating that account to say, fund tax cuts for wealthy individuals and corporations.

    Second, it was only in 1970, some 35 years after Social Security was created and 5 years after Medicare was created that the US adopted a so-called "Unified Budget" under a Republican president --- Richard Nixon as the economy suffered under the war that a Democratic president started (and didn't run again), but the Republican Nixon dramatically escalated.

    Third, and of course it was only in the 29 years since 1980, 20 of which we had a Republican President and over 15 of which had Republican-led Congresses that raids on the SSI trust fund dramatically escalated. Almost entirely to fund corporate giveaways and tax cuts for the wealthy.

    So I don't think there would be much chance a national health insurance system created by Democrats would be raided. At least not anywhere near to the extent Republicans have demonstrated they would rob it to give money to their rich buddies and corporations. And while I was opposed to corporate bailouts, it has to be noted that the first big round that cast the die for all that followed was in Sept 2008 while Bush and the Republicans still held power.

    You're just wrong Joe White about a lot of what you say. The sooner you accept you are not going to get away with making bogus assertions, the sooner we can actually talk about fixing our health insurance system as only we can do with a national health insurance plan that is unquestionably in the best interest of small and large American businesses that by far employ most of the working people in this country.

  • AdmiralNaismith (unverified)
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    Senator Sessions, Senator Coburn, and Senator Cornyn are all Republicans. I never said that a Democrat would filibuster their own bill. I stated that they may not vote to end the filibuster from a Republican.

    Okay, when I say "joining a filibuster", I mean the same thing you mean when you say "not vote to end the filibuster". A filibuster IS voting no on cloture. And any Democrat who joins the Republicans on that filibuster would be committing murder-suicide on the Democratic party for the foreseeable future, and would be destined to have his or her last name replace "quisling" in the dictionary. That Democrat would have to be an even bigger pigheaded lunatic than any politician I can think of.

  • David from Eugene (unverified)
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    Without a strong robust public option there is no reform. The big problem with the rest of the plan is that it does not reform the system in any meaning full way.

    Take the access for people with preexisting conditions; yes the insurance companies have to sell them a policy, but there is no limit to either the premium amount or to the terms. So if you can afford $2000 a month for a policy with a $100,000 deductible you are OK if not you are a criminal.

    Then there is the matter of rescission; the Presidents proposal exempts fraud from the no cancellation rule. As the insurance companies consider not reporting every preexisting condition as fraud they can still cancel your policy. Besides even if you sue them the suit ends with your death. So you have a choice spend you money on doctors or on lawyers.

    If you can’t afford your policy they will give you a tax credit. Which only helps if your taxes are greater then your premium.

    The insurance exchange sounds good but without a robust public option there is nothing to force the insurance companies to reduce their rates. Besides it does not go into effect for four years assuming the Republicans do not get in control and repeal it.

    As to the “high risk pool” paying a high premium for a high deductible policy is no help if you don’t have enough the money to pay the deductible.

    That brings us to tort reform, it does not reduce costs but it does let the bad doctors get away with murder.

    It is much better to put forward a strong but reasonable bill with a robust public option. Inform the members of the Senate Democratic Caucus that the vote for closure or they are out of the party. If the Republicans filibuster then we hang the failure on them using the numbers, 18,000 dead because of lack of insurance, 30 million uninsured, 17,000 new uninsured a month, annual double digit premium increases, 450,000 bankruptcies a year leaving American businesses to eat a $90 million dollar loss.

    Now is the time to play hardball not to roll over and play dead before an astroturf mob.

  • PNP (unverified)
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    By early June Howard Dean was saying here in Portland that it had been a strategic mistake by President Obama to let "robust public option" become the left pole of the debate. It isn't clear to me if Dean had argued against this within the HCAN/ Obama strategy discussions or if he was admitting error himself.

    Actually Chris, I don't think this argument holds any water. I know all about the whole "good-cop/bad-cop" political tactic of making sure you have a mean and tough faction pushing the extremes so another more moderate seeming faction can say to the other side "You can deal with those unreasonable people, OR you can deal with US". That is the strategy the disempowered use and grassroots groups I've worked with over the years have successfully used it to devastating effect.

    Since Clinton utterly prostituted our Party to corporate America, the health insurance reform debate has been a battle entirely between wings of the Democratic Party. (And this is one political fight I have no problem characterizing morally as being between those who represent evil and those who represent good in our Party because it is about life and death. Only war is even more about a battle between those who represent evil and those who represent good in the Party.) Republicans have NEVER been on board, their goal has always been and remains rolling back all current plans including Medicaid. That's exactly why Wyden set out from day one to work with them rather than Democrats and anybody who wants to argue otherwise is ignorant. Wyden has NEVER been an honorable upholder of core Democratic values in the healthcare debate.

    People who know me are stilling apologizing for calling me every name in the book as a traitor to my own party when I told them five years ago that in the developing health care battle we were going to have to fight Democrats hardest, including Howard Dean. Most people must not remember Dean was all but a Rockefeller Republican who happened to have a "D" after his name in 2004. So much so that his four-point 2004 plan in it's entirety was:

    1) Raise the income limits to make more people eligible for Medicaid (which is implemented mainly as private insurance in Oregon as OHP). 2) Raise the income level of families eligible for subsidies to buy into SCHIP (which actually is implemented as private health insurance in many states including Oregon.) 3) As Obama is proposing, create an equivalent to the FEHBP, again a program that is based on private health insurance, that employers could buy for their employees rather than other private insurance plans. 4) An expanded business tax deduction to encourage more companies to buy health insurance for their employees.

    He and his punk kid netroots had no respect and no time for those like PNHP who had already been working on real health insurance reform for almost 20 years. I was not and am not a PNHP member, and actually split with PNHP on precisely this issue, but I opposed Dean because of his old-school Republican health care plan and how he gave single-payer advocates the back of his hand. Well, that and because I could see how popular he was with dumb NW Democrats (no apologies will escape my lips for the truth) who couldn't even say what his key platform positions were. (Just as most of the same ignoramuses couldn't tell you what Obama's platform positions were --- starting with his pledge to escalate the war in Afghanistan --- if their life depended on it.) So while I think we should appreciate Dean's efforts since 2008, I don't take him to be a credible voice for what we as health insurance reform advocates should have been doing and should be doing. Not by a long shot.

    No, a strong publicly-owned, publicly-accountable, publicly-managed plan, that anyone could vote with their dollars to chose, Medicare Part E if you will, is exactly what we should have proposed, did propose, and should continue to demand the Democratic majority give us or we will fire them. Aside from the PR value of honest, moral consistency in sticking with that plan, it is exactly the kind of health insurance reform that exposes the utter hypocrisy and moral vacuousness of the Clinton-Obama-corporate wing of the Democratic Party. It leaves them no argument except to lie about what they stand for. That proposal is what is in the best interest of small business and every poor and working person they lie they represent.

    It's even good for large corporations, but they don't need our help in this battle --- if they were to step up and do the right thing it would be all over.

    It's only steadfast support for that plan, and issuing a promise that we will make it priority #1 to defeat any Democrat who doesn't bully their fellow Senators and Representatives into giving us that kind of plan that can win the day in this battle where the stakes literally are life and death. And that's been true all the way back to the Clinton years, and certainly since Dean ran in 2004.

  • (Show?)

    PNP, I wasn't plumping for Dean. Didn't actually have any candidate I liked much in 2004. He remains part of the problem of saying the words "strong" or "robust" public option without giving them any content -- just as you say, while showing exactly how that could be done. It is sad that even the Progressive Caucus members who have actually specified some minima have made them minimal compared to what you describe, or the original ideas circulated by Jacob Hacker (which are not as good in terms of clarity about the public entity).

    But I still think Dean was right in June, exactly because among other things single payer can be used to identify dimensions of the crisis in a clear, not overly detailed way and criteria of strength, and demand stands taken on them. Also I don't think he was talking just about the DP, but including the efforts of HCAN to create a popular constituency, and about relationships to the media and how they frame things.

    What is left out of your picture of "two wings" (I'd argue for a blurry & unstable middle between poles) of the party in the current debates is the lobbyists. Once the only criterion became "what we can get through Congress," that gave the lobbyists huge leverage, seen e.g. in the "Schumer Principle" that public sector efficiencies were to be ruled out of bounds.

  • RyanLeo (unverified)
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    Admiral Naismith,

    Wow, I never considered it that way. Thanks for teaching me another perspective. You are exactly right if you look at it that way.

    PNP,

    Republicans would see right through that proposal of giving Medicare to everyone as a trojan horse for the single payer system that it would become.

    Here are a few questions:

    1. Under Medicare for all, would I have the option to opt out of it, stop the Government from taking it out of my paycheck, and use it to get private health insurance coverage instead?

    2. Is the monthly fee a flat rate for everyone? Would those who use it very rarely (like myself would be) pay significantly less per month than those 65 years and older?

    3. Do you envision a private health insurance industry if Medicare for all is enacted?

    4. Will children have to pay significantly higher rates when they reach working age in order to pay for the healthcare that was collectively given to them by each and every taxpayer paying into Medicare?

    5. Do you foresee visible rationing of healthcare under Medicare for all? For example, would there be limits on elective surgeries for those 65 years or older?

    I am interested in this proposal.

  • (Show?)

    PNP, Regarding my earlier comment to evil is evil and Emmit Goldman, I probably was getting myself into a bit of just the kind of trouble that concerns me. The fact of the matter is that the single payer movement straddles the inside-outside division & debates among left-progressives.

    I work on single payer in two organizations as a volunteer that have paid staff, locally and more consistently in the Portland Jobs with Justice Healthcare Committee and need to do better with Progressive Democrats of America for a national connection.

    In JwJ, our committee has people with a range of politics, but one of the committee's main activities has been getting endorsements of HR 676 from union locals and central labor councils and building rank & file connections in the unions. This means interactions with people with strong DP commitments. We also work with the Labor Campaign for Single Payer, which is headed up by Mark Dudzik, who is also national organizer for what remains of the Labor Party (actually my guess is that his work represents LP is putting most of its efforts into the Labor Campaign) (I was active in the LP in the mid-late 1990s, mostly in Boston). We have cooperated closely with the Nader-linked Single Payer Action since it emerged earlier this year, and also with a new pro-single payer group that emerged in Tigard as an outgrowth of a very active Obama campaign group some of the most active of whom retain intense loyalty to him.

    At least in the JwJ context, the alienation of many from the health care politics of the DP leadership and Obama, and criticism of them, are nothing new, and in a lot of ways predate Obama's presidency; his particular exclusion of single payer is a continuation of a long pattern, as you know. gut that's a different thing to saying "no difference at all between Obama & McCain," which is an argument I don't want to get sidetracked into -- though as I say my response risks just that.

    I suppose there are probably people who would argue that we won't get single payer until the major party duopoly is broken down, but on the whole the movement has been cooperating pretty well across the divisions of opinion about the DP. That's really all I was trying to get at.

    In some ways I would think that strong public plan advocates might feel more disappointed in Obama than single payer people, especially if as you say they didn't pay close attention to his actual positions as a candidate.

  • (Show?)

    RyanLeo, possibly PNP will want to answer you directly from his/her own perspective. Those of us who are working directly now for a single payer system mostly refer to H.R. 676, "United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act)." The act is about 16 pages long in pdf form and I encourage you to read it yourself.

    The short answers to your questions are: Questions 1-2, No, question 3, mostly No, only a small one (though in some single payer sysems like France and Taiwan there is more extensive secondary supplementary insurance) question 4, No, question 5, No to your specific example, beyond that it will depend on what you mean by rationing and whether we can agree on that.

    H.R. 676 is a social insurance bill. Social insurance, though it uses the same word, is almost exactly the opposite in principle to actuarial insurance. Rather than dividing people up according to their relative risk at any given point in time, or their life course, and charging differentially and/or excluding people based on such divisions, social insurance treats the entire population as a universal risk pool. At any given time, roughly 20% of the population need medical treatment and 80% don't, and pretty much all of us are going to end up in both categories over the course of our lives.

    Social insurance is a social contract in which we pay not only for the treatment we may need at one time or another, but for the security of knowing we will be able to get it without being threatened by personal bankruptcy, or invisibly rationed out of needed care by inability to afford it. Finally, we pay for the shared benefits of having an overall healthier population, which include less pain, greater well-being physically and mentally/spiritually, less worry, lower costs, greater productivity, less time on unpaid caregiving to family and friends, and less need for it due to less debility, and so on.

    Under H.R. 676, this would be paid for by taxes. I'll refer you to the bill for details. An important aspect of it is that it would address the fiscal problems of Medicare by folding its higher risk population into the universal risk pool. Unlike current Medicare there would be no premiums, which for seniors would mean the end of deductions from their Social Security. Nor would there be deductibles or co-pays, bringing an end to medical bankruptcies.

    The basic principle would be "Everybody in, Nobody out." There would be genuine universality of everyone residing in the country. The extension of care to everyone would be paid for in a number of ways. Most immediately there would be very large savings realized by elimination of the massive inefficient private bureaucracies in insurance companies, hospitals and doctors offices, and employers, needed to deal with billing and claims filing and denials and appeals and so on, along with the elimination of the insurance company profit portion of premium costs. This is estimated to save between 20% to 30% of current overall health insurance costs, depending on your estimate of Medicare overhead, usually estimated between 4% to 8%, which is taken as a proxy for the expanded system's overhead. That savings in itself would be large enough to include everyone in the system.

    There would also be short and long term savings from reduction in expensive forms of treatment. A piece of this would be the infamous and expensive use of emergency departments for primary care, which would occur relatively quickly. Some other savings would take longer to work their way into the system, deriving from a shift in emphasis to health promotion and prevention of illness and injury, to primary care, and to detection and well managed treatment of chronic diseases at an earlier point in their course, when treatments are both less expensive and more likely to be effective. (This is an aspect of the answer to your wrong-headed question about health spending on children, btw -- apart from moral repulsiveness of treating children as freeloaders, good health promotion and primary care, particularly in the first four years or so of life, massively reduce demand for expensive treatments in adulthood.)

    It's late and this is long so I will leave it there for now, but will try to address some issues of transition (job loss in billing and insurance administration, job creation and training needs in care provision) and rationing tomorrow.

  • Joe White (unverified)
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    If we could just have a good system like Canada

    Why can't we learn how to do it from our neighbors to the north?

  • (Show?)

    PNP,

    Thanks for taking that on.

    The message from "cam balkon" is word for word the same as a post made by "Joe White" earlier in the thread. They have different IP addresses, though "Joe White"'s own IP addresses change daily it seems, maybe using an anonymizing site/mail address provider. The "web" link for "cam balkon" would open an attachment if I clicked on it.

    The text only appears on this site, so it does not seem to be a common source spam talking point. It would be bizarre as sock-puppetry.

    Thus it seems to be some weird kind of quasi-phishing type thing from "cam balkon" that mirrors extant content. I am going to remove that post because of the suspect web link; the same text is linked at "Joe White"'s post.

    The "9-11 moment of silence" item, on the other hand, pulls up 10,400 Google hits on the exact text of the first sentence, those I've looked at have the whole text in commments sections around the web. This appears to be some kind of roborumor-spam used to spread MacGauhhey's fear mongering, which was one of the sources of Sarah Palin's "death panel" fantasy and was widely debunked a number of weeks ago.

  • Joe White (unverified)
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    Chris,

    Thanks for addressing the cam balkon post.

    Not sure why he/she cut and pasted my comment. I saw it earlier and thought it was an odd thing to do.

    I can assure you that I speak only for myself, not any others.

    I notice that BO does seem to have quite a problem with spammers inserting generic comments 'thanks for that helpful information' kind of stuff and links to unrelated sites.

    I hope they (you? I really don't know who's in charge there) get that under control or it could do serious damage to the site's reputation. Probably the easiest way would be to disable links in the signature, but I don't know if you can do it without disabling links in the text of a poster's comments.

    Good luck with it though.

  • (Show?)

    You're welcome Joe. The overall technical configurations are handled by Mandate Media, I presume policy-wise in consultation among the editors, but constrained by the limitations of TypePad. Individual "contributors" like myself have a certain amount of editorial control over comments on our own posts, e.g. can report spam & then delete it. Not sure if I can go into messages and remove content and leave a note behind, though the editors can.

    It does seem as if there may be a TypePad based constraint on the "URL" function that it has to be filled with something. At one point if you didn't put something it automatically filled in the e-mail address you used as the note reflects, though I'm not actually sure it really still does that. The possibility of having a default fill-in using BlueOregon.com occurs to me to wonder about.

  • Ms Mel Harmon (unverified)
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    If we don't get a public option of some sort, there had best not be anything in what is passed that mandates coverage. If you don't give people a public option but require them to have insurance, it's simply wrong.

    And if we don't have mandated insurance and we don't have public option, what is left? Can we even call it reform?

  • backbeat (unverified)
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    What do you think? Is a weak public plan worth fighting for?

    NO

  • backbeat (unverified)
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    Well, the physicians agree with us

    http://www.dailykos.com/storyonly/2009/9/14/781924/-Update-2X-BREAKING:-US-Physicians-Enthusiastically-Support-Public-Option-

  • Emmit Goldman (unverified)
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    PNP said, "Aside from the PR value of honest, moral consistency in sticking with that plan, it is exactly the kind of health insurance reform that exposes the utter hypocrisy and moral vacuousness of the Clinton-Obama-corporate wing of the Democratic Party."

    Well said. And thanks also to Joe Hill for "Crush the DLC once and for all and have it out with the corporate wing of the Democratic Party." I'm not a Democrat, but I would join a party that was led by the likes of Joe Hill or PNP in a second.

    As to the rest of the DP, I get it now. There's NOTHING the Dear Leader might do that would cause you to say, "Enough!"

    Chris Hedges (Stop Begging Obama and Get Mad, http://www.truthdig.com/report/item/20090914_stop_begging_obama_to_be_obama_and_get_mad/) says:

    The right-wing accusations against Barack Obama are true. He is a socialist, although he practices socialism for corporations. He is squandering the country’s future with deficits that can never be repaid. He has retained and even bolstered our surveillance state to spy on Americans. He is forcing us to buy into a health care system that will enrich corporations and expand the abuse of our for-profit medical care. He will not stanch unemployment. He will not end our wars. He will not rebuild the nation. He is a tool of the corporate state.

    The right wing is not wrong. It is not the problem. We are the problem. If we do not tap into the justifiable anger sweeping across the nation, if we do not militantly push back against corporate fraud and imperial wars that we cannot win or afford, the political vacuum we have created will be filled with right-wing lunatics and proto-fascists. The goons will inherit power not because they are astute, but because we are weak and inept.

  • Emmit Goldman (unverified)
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    I forgot to express solidarity with evil is evil, who is absolutely correct about Obama's impeachable offenses. Those of you who (correctly) called for the impeachment of Bush for his crimes are hypocrites for supporting Obama in the commission of the same crimes.

    Evil is evil.

  • rw (unverified)
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    Joe, the site has a good reputation, deserved or not. Or, shall we say, local public radio seem to find nothing else to quote on an increasing basis. You stand a chance of being read here, and of being quoted from here, spammers notwithstanding.

    My suspicion is that any intelligent person Gets It that if you spend your time editing out that nike shoe shit, you inspire the troll to double their activities.

    For now, there's not much danger to BO being less-quoted, as we have a veritable fishwrap for our primary paper, and local news outlets are template devices.

  • rw (unverified)
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    Chris, the URL defaults to BO.com. If the Email defaults likewise, it will make it difficult for Kari to 1. count the number of posts on any offending party; 2. potentially auto-disable posts on any given offending email addy.

  • Nick Pell (unverified)
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    Of course all of this obscures the issue that Obama and the Congressional Democrats have placated the far right on virtually every aspect of health care reform in this country. Sarah Palin said there were going to be "death panels" on Facebook. We lost end of life care. Joe Wilson shrieked about "illegals" getting free health care. Congress immediately began bending over backwards to make sure that undocumented workers wouldn't have access.

    When will people learn?

  • (Show?)

    Nick,

    Actually it's a question about the consequence of what you describe, and what people from different perspectives think about what to do about it.

    Maybe it skips the step of going more deeply into how we got there, though I think some views of that come out in the comments.

    Mel,

    A few things would be left, at least as of now. The restrictions against denying coverage based on pre-existing conditions and tighter regulation of rescission would stay. I think maybe also limitation against rate discrimination on any demographic character except age. As PNP has discussed in some long comments above the creation of an Exchange and an administrative body -- similar to what has happened in the Oregon state reform process as he/she notes.

    Also I believe that the subsidy structure for those who bought private insurance within the Exchange would still be there.

    Your concern about the individual mandate is well-taken, although at this point, given the restrictions on the public plans that still are in play to resemble private plans, I don't think any of those public plans would help much with the "pay for lemon insurance or get punished with a fine or appeal for the right to be uninsured (!) " problem that a lot of lower and lower middle income individuals and families will face under the individual mandate. The federal employee insurance widely touted as the model has three tiers and the "affordable" tier works through really high deductibles and co-pays just like any other "affordable" plan -- because that insurance is actually a BC/BS plan anyway.

  • (Show?)

    Nick,

    Actually it's a question about the consequence of what you describe, and what people from different perspectives think about what to do about it.

    Maybe it skips the step of going more deeply into how we got there, though I think some views of that come out in the comments.

    Mel,

    A few things would be left, at least as of now. The restrictions against denying coverage based on pre-existing conditions and tighter regulation of rescission would stay. I think maybe also limitation against rate discrimination on any demographic character except age. As PNP has discussed in some long comments above the creation of an Exchange and an administrative body -- similar to what has happened in the Oregon state reform process as he/she notes.

    Also I believe that the subsidy structure for those who bought private insurance within the Exchange would still be there.

    Your concern about the individual mandate is well-taken, although at this point, given the restrictions on the public plans that still are in play to resemble private plans, I don't think any of those public plans would help much with the "pay for lemon insurance or get punished with a fine or appeal for the right to be uninsured (!) " problem that a lot of lower and lower middle income individuals and families will face under the individual mandate. The federal employee insurance widely touted as the model has three tiers and the "affordable" tier works through really high deductibles and co-pays just like any other "affordable" plan -- because that insurance is actually a BC/BS plan anyway.

  • (Show?)

    Administrivia: Yes, as our content-based spam filters have gotten better, the spammers have started copying legit comments and then adding links. I regularly remove lots of that sort of spam, but was traveling this weekend...

    Good job, everyone, on ignoring obvious concern trolls like "evil" and "anon". These guys are trying too hard.

  • rw (unverified)
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    Yah, about the "concern trolls". Obvious. And annoying to run across a full page of spam, but it's just part of the game. It's either that or Kari spends all of his time moderating.

    Have noticed that OPB's Think Out Loud now uses BO as a reference point on nearly every show of late. Not saying that's bad - but it makes me wish we had a more thriving and useful media scene here. If we are as good as it gets, help everyone, as good as we are! Heh.

  • Joe White (unverified)
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    rw wrote:

    "Joe, the site has a good reputation, deserved or not."

    I think you may have misunderstood my point.

    A site that gets loaded up with spammy links gets a bad rep with the search engines.

    I wasn't referring to what it's readers might think.

    BO obviously has lots of blue fans that love it. And a few of us conservatives who love to talk with folks who don't necessarily share our views.

    I appreciate the hospitality of those who have been kind enough to talk about the issues.

  • RyanLeo (unverified)
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    Backbeat,

    What the US Senate Finance Committee is doing may be the deal breaker on whether any health care reform is passed. This is the committee where you have the bi-partisan group of 6 (3 Dems;3 Reps)Senators crafting a bill that will get 60 votes. Here is the latest from AP:

    http://news.yahoo.com/s/ap/20090915/ap_on_go_co/us_health_care_overhaul

    The way I read it, there is no public option in it, but it "would require all Americans to get health insurance, either through an employer, a government program, or on their own." If my instincts are right, Baucus's bi-partisan health plan will have tax credits so that the uninsured can receive health care coverage via Medicaid. I could be wrong.

    60 votes, the Democrats absolutely need 60 votes because Olympia Snow (D-Maine) will not vote on a cloture to end a filibuster if that is the path chosen by Senate Republicans.

  • RyanLeo (unverified)
    (Show?)

    Backbeat,

    What the US Senate Finance Committee is doing may be the deal breaker on whether any health care reform is passed. This is the committee where you have the bi-partisan group of 6 (3 Dems;3 Reps)Senators crafting a bill that will get 60 votes. Here is the latest from AP:

    http://news.yahoo.com/s/ap/20090915/ap_on_go_co/us_health_care_overhaul

    The way I read it, there is no public option in it, but it "would require all Americans to get health insurance, either through an employer, a government program, or on their own." If my instincts are right, Baucus's bi-partisan health plan will have tax credits so that the uninsured can receive health care coverage via Medicaid. I could be wrong.

    60 votes, the Democrats absolutely need 60 votes because Olympia Snow (D-Maine) will not vote on a cloture to end a filibuster if that is the path chosen by Senate Republicans.

  • rw (unverified)
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    Hey Joe - I actually WAS thinking about the local readership. But I see what you mean there.

    I think there are a good number of good minds here, and I get frustrated with the cheerleadery stuff myself. Just as frustrated with the curmudgeons who come up here only to stomp around Being Non-Liberals or Rantingly Angry Leftist Immoderates... either position is stale to my lights. :)...

    I was thinking more that I do not know that BO deserves to be so-quoted, particularly since I"m not hearing the quotes to be of a high calibre, nor the presenters on Think Out Loud particularly strong or concepted. So it's all still kind of bland yet, and does not feel to me to have any real meaning. It's as if someone thinks this is a blog of influence and influential people watching, so it's being referenced. I'd rather there be a specifically sound reason for even mentioning BO besides "somebody commented on this over there".

    I wish we had maybe two more strong resources in this area to create a dynamic exchange situation. I do not count Willamette Week as anything but a guilty diversion on the same level as that reality TV you ALL know you are sneaking on the side. And the mainstream media is what you expect it to be.

    It seems BO is being referenced more and more, and so up here it would be great to see more civil and sound discourse and less caterwauling, less fisticuffs -- let this become a place of erudition from all stripes and more than a cheering section of the Dem faithful. I'd love it if the contrarians would willingly shed their positions and dedicate themselves to discourse instead of reaction. And surprise the whole damn lot of them who watch BO. We don't have to all get along, that is sure: but we might just raise the calibre of the thing if we staunchly turned our minds to it and assumed intellect behind every comment. I'm always pleased and actually heart-moved when someone civilly attends to a potentially-inflamatory riposte - and it slips up to a different level for moments. I love it when that occurs.

    Wouldn't that be great? If lively and well-thought-out scuffles were being quoted in specific instead of mushy references to "some bloggers on BO you wanna check it out".... yawn. :)...

  • Colon Cleanse 3000 Review (unverified)
    (Show?)

    Great article! Thanks a lot for sharing this... It would really be a big help...

  • joel dan walls (unverified)
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    Yo Joe, my Canadian friends like their medical care just fine. I just spoke to one who lives in Vancouver and is going through chemotherapy following surgery. No delays with ANYTHING. No crippling bills. Oh yeah, this friend's father was an MD who was also perfectly happy to operate within the Canadian system.

  • joel dan walls (unverified)
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    There truly is a fundamental disconnect between myself and someone like Joe White. It's an ideological difference.

    I consider the provision of UNIVERSAL MEDICAL CARE to be a measure of a decent, sane society. Joe White does not. For Joe, laissez-faire economics and some sort of goofy fantasy about "individualism" and "free choice" trumps everything.

    There really isn't a middle ground here, folks. Let's quit pretending that there is.

  • Joe White (unverified)
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    jdw wrote:

    "Yo Joe, my Canadian friends like their medical care just fine."

    Dr Anne Doig , incoming President of the Canadian Medical Association said:

    "We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize..."

    jdw wrote:

    "There truly is a fundamental disconnect between myself and someone like Joe White. It's an ideological difference."

    True. I am prone to look at facts, not simply believe promises.

    Your faith in government as the solution to all is great if it gives you comfort, jdw. I just don't share it.

    jdw wrote:

    "For Joe, laissez-faire economics and some sort of goofy fantasy about "individualism" and "free choice" trumps everything. There really isn't a middle ground here, folks. Let's quit pretending that there is."

    True. I believe in letting people choose what kind of health coverage they want.

    You apparently think that having choices available is 'goofy'.

  • joel dan walls (unverified)
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    I believe in letting people choose whether or not to wear motorcycle helmets. Joe White, rest assured that I will defend to the death your inalienable right to risk spending the rest of your life brain-dead at public expense.

  • Joe White (unverified)
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    jdw,

    I'd be interested in hearing your reaction to Canada's top doc when she said Canadians don't realize their system is going down the toilet.

    Sure your pals up north like their system, they just doesn't know it's unsustainable and imploding.

    I wonder why Canadian politicians haven't informed their constituents how badly off the health care system is?

    I guess I just answered my own question.

    But you'll trust the pols HERE to tell you the truth, wont you jdw?

  • LT (unverified)
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    OK, here's a bold proposal: Put the public option up for a vote and see how many votes it gets.

    If not enough votes, how is this for an alternative? a) End insurance anti-trust exemption and regulate the companies strictly. b) Implementation date: ending the pre-existing condition nonsense, dumping people for getting sick, lifetime caps, etc. goes into effect this year.

    If it takes longer to figure out how to cover everyone, maybe that is necessary, although unwise. But with the worries about the H1N1 flu around, does this country really want a bunch of people who worry about the cost of seeking medical help if they are coughing and have a fever?

  • Emmit Goldman (unverified)
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    Re: "I do hope you realize that you don't speak for the whole or even I venture to say a majority of the single payer movement in the character of your criticism of Obama."

    That's the problem. When the worshipers wake up and see that Obama is not the secular mystical icon that they think he is, then decency has a chance. Until then, nothing remotely progressive can happen.

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