Center on Budget on Health Care Bill

Steve Novick

In response to my friends (and my mother!) who think we should just kill the health care bill: The Center on Budget and Policy Priorities has been a vigorous advocate for low- and moderate-income people for decades. I think it's important that CBPP believes that even though the bill requires us all to buy insurance in the ugly private insurance market, the subsidies that the bill gives to families with up to $88,000 in income, plus the promise of coverage regardless of preexisting conditions, plus the other provisions in the bill, make it worthwhile. I'm reproducing excerpting their most recent analysis below. 

Believe me, this is not what I wanted. Hell, I'm right now fighting with Regence because they won't cover my checkups with my glaucoma doctor! But the way the system controls costs now is by denying people insurance. If this bill fails that process will accelerate. Bring everybody under the tent, making the government responsible for subsidizing costs for lower-income people, paying for it at least in part with a progressive reform to the Medicare tax ... I don't see how we can say 'no.' 

Here's CBPP:

Reforms Expand Coverage and Make Insurance More Affordable

The health reform legislation would expand coverage to 32 million uninsured people through a significant expansion of Medicaid, as well as premium and cost-sharing credits for low- and moderate-income individuals and families who do not have employer-based insurance and who do not qualify for Medicaid or Medicare.

Premium and Cost-Sharing Credits for Low- and Moderate-Income People

Individuals and families who have incomes above the level needed to qualify for Medicaid but below 400 percent of the poverty line would receive “premium credits” to help them purchase health insurance in the new health insurance exchanges (discussed below). For example, under the health reform legislation, a family of three earning $32,000 (175 percent of the poverty line for a family of that size) would receive a credit that would limit its annual premium to about $1,500 (if the health reform bill were in effect in 2010). In addition, the legislation would provide additional cost-sharing subsidies (that is, assistance with deductibles and copayments) to people earning less than 250 percent of the poverty line to ensure that they can actually afford to see a doctor and seek care. The maximum out-of-pocket costs a family of three earning $32,000 would have to pay each year (in addition to the insurance premiums) would be about $2,000.

Expanded Medicaid Eligibility for the Lowest-Income People

The plan would expand Medicaid up to 133 percent of the poverty line for all children and adults younger than 65 who are lawfully residing in the United States and not eligible for Medicare. This would mean that millions of low-income parents, as well non-disabled low-income adults who do not have dependent children (and who are generally ineligible for Medicaid today except in a small number of states with waivers), would become newly eligible for health coverage through Medicaid. The federal government would pick up 100 percent of states’ Medicaid costs related to this expansion for three years, with that percentage phasing down to 90 percent for 2020 and subsequent years. Recognizing the need for increased capacity to serve new enrollees, the plan would also increase primary care provider payments to 100 percent of Medicare rates during 2013 and 2014, with the federal government covering the full cost of these rate increases.

Medicaid is the most cost-effective way to provide comprehensive and affordable coverage to people with very low incomes and thereby ensure that the low-income uninsured gain coverage. Medicaid beneficiaries generally do not pay premiums and are required to pay only modest co-payments. Medicaid covers a broad array of services and supports well-suited to the needs of low-income people (especially children and people with disabilities), who are more likely than people with higher incomes to be in fair or poor health. Medicaid is also significantly less costly, on a per-beneficiary basis, than private insurance (after adjusting for health status), largely due to its lower provider rates and administrative costs.

[Editor's note: Original post contained entirety of CBPP's analysis, including a bunch of broken navigation. Read the rest here.]

Comments

  • (Show?)

    The purists on the left that would sink this bill because it is not single payer remind me of Nader who claimed their was no difference between Bush and Gore and helped bring on the Iraq war. If this bill fails we do not get single payer. That is not the option on the table and will not be for years. The current mess is what we will continue to have and that means a lack of insurance for tens of millions and no cost controls. If it passes we can continue to improve it.

  • Bill Bodden (unverified)
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    This bill falls so far short of a good bill I would not criticize anyone who rejects it. On the other hand, it does have some benefits for many people so I would not criticize those, such as Kucinich, who switched from a no to a yes vote. It's a damned-if-you-do-damned-if-you-don't vote.

    A health economist from Harvard was discussing the bill this morning on C-Span. He appeared unequivocal about one point: It's a good bill for the insurance corporations.

    In a way, this fight for health care reform is something like the fight for civil rights. Can you imagine what MLK, Jr and his supporters would have done if Congress and the president had offered them civil rights for any African-American with fifty percent or more white (?) blood in them but others with less would have to put up with sitting in the back of the bus and other indignities?

  • bjc (unverified)
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    I think whether this is a good plan or a bad plan depends heavily on how states administer it, particularly the exchanges. How much confidence do you have in the Oregon Insurance Division?

  • Kurt Hagadakis (unverified)
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    Nice rebutt to John, Bill! I would agree. Are there any more pure leftists on this board?

  • Bluecollar Libertarian (unverified)
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    Before you get your knickers in a twist you may wish to read this Newsweek piece. Look at the numbers and at who is playing games.

    “That doctors demanded protection for their wallets strikes Howard Brody, a family physician at the University of Texas Medical Branch, as "ethically questionable," and not only because he thinks doctors have a moral obligation to help get the nation's health-care bill under control. The bigger problem is that "doctors rip off the system with inappropriate care," says Brody. An estimated one fifth to one third of U.S. health-care costs, at least $500 billion a year, goes toward tests and treatments that do not benefit patients—routine CT scans in the ER, antibiotics for colds, Pap tests for women who do not have a cervix, and …” http://www.newsweek.com/id/234514

  • (Show?)

    What's on the table now is a steaming pile of shinola brought to you by Ron Wyden (R-N.Y.). Nader was right about that guy. No wonder Ron Saxton likes him so much.

    I don't know how you can call yourself a progressive, Steve. On this one, you sound to me like a party hack.

  • Ted (unverified)
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    I ask people to remember the bank bailout bill. The curiosity of that bill was the same as this bill. An unusual alignment of conservatives and liberals came out in opposition of the bank bailout. The Treasury Secretary that GW Bush fired for disagreeing with (among other things like the Iraq War), Mr. Paul O'Neill said it was a bad idea. James Galbraith of Univ. of Texas, one of the biggest academic stars on the left, was vociferous in saying the bailout may not make anything better, but might very well make things worse. A bipartisan chorus of voices came out in opposition, but none of them got any traction in the media. Both parties called for the bailout, Dems more than conservatives even.

    Their voices were squelched. Once again a bill that nobody is willing to stand up and say is a good bill is being forced through for a vote at the 11th hour. Once again the benefit to large corporations (this time drug, insurance, and medical companies) is assured. The benefits to the people who the bill is promoted as supporting are played off as "an important step toward," or "the best we can do." Funny how the "best they can do" is always so much better for the big industrial cartels that pretend to be "competitive" and "capitalistic," than it is for the lower 95% of the income distribution.

    Could it very well be that the bailout bill made things worse? Perhaps much worse, than it might have been? Could it be that this bill, which no party has the gumption to proclaim pride for, will only make things worse?

    Please... Think for yourself.

  • Details Count (unverified)
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    Bill Bodden, in one the few truthful statements anywhere on Blue Oregon today about this health care bill, wrote:

    It's a good bill for the insurance corporations.

    In late breaking news, It also turns out it's also likely to be a very good bill for right-wingers who don't believe that a woman's reproductive health decisions should be between her and her doctor.

    Stupak Abortion Language to Be Substituted for Senate Language in Deal to Secure Health Care Votes

    The Stupak Amendment Is Back: What’s an Enrollment Corrections Bill?

    Bill Bodden, I do criticize those Democrats who support this bill at this time because they actually haven't read it. Many of the supposed benefits, are illusory or actually far less than as represented.

    After watching Amy Goodman's interview with Dennis Kucinich yesterday, in which he came across as in obvious psychological distress, I believe Obama, Pelosi, and the leadership hurt him in the only way they actually could: through intentional emotional blackmail.

    As Kucinich recounted right in that interview, his family had to move 21 times as he was growing up, and even lived in their car at one point. His public service career over the last 30 years or so has been as true to the values of defending the poor and disempowered against the selfish predators in our country as in any politician. Obama had the audacity, and complete lack of any discernible moral integrity, to go to Kucinich district and hold a rally in which he indisputably invited the implicature he (Obama) cared about the people in Kucinich's district, not Kucinich.

    There is no evidence to the contrary, and it would be in character with the utter lack of any moral scruples we have seen in this health care debate, for the Democratic "leadership", totally concerned only with themselves, to have made it clear that they would use the propaganda means at their disposal to attach Kucinich's name every time they act on their inclination to screw working and poor people. That would include thumbing their nose at the American people and refusing to do anything, much less the right thing, if this bill is defeated, since they can find a lot easier path to re-election by playing ball with the insurance companies and the rest of corporate America.

    If you need further proof, today at GMU Obama said this with an enthusiasm and apparent belief he was speaking profound truth to an adoring crowd that was downright scary:

    At the heart of this debate is the question of whether we’re going to accept a system that works better for the insurance companies than it does for the American people -- (applause) -- because if this vote fails, the insurance industry will continue to run amok. They will continue to deny people coverage. They will continue to deny people care. They will continue to jack up premiums 40 or 50 or 60 percent as they have in the last few weeks without any accountability whatsoever.

    This bill with it's mandate, and by CBO scoring, is one of the biggest government-granted windfalls for the insurance industry and corporate America in recent history. There's a properly used word in the English language for that, but I wouldn't use it here just to deny the mindless, shrieking mob here the chance to respond like the mindless, shrieking mob.

    This bill does not guaranty anyone coverage, it only guarantees that 4 years from now you will have one more private insurance option of a policy whose benefits we don't know yet, and which will be determined as constrained by the required cost numbers. If you are lucky to have statistics on your side and your medical issues happen to be those which have been included in the policy, you're golden. If not, you're SOL because you are not protected. That is fundamentally different than how Medicare works.

    Finally, as we saw two days ago, and this little piece in Life & Health National Underwriter reports:

    WASHINGTON—As health care reform heads for a possible House vote by Sunday, Mar. 21, rate regulation provisions the Obama administration had touted as critical—and industry officials saw as their greatest concern—are absent from the bill the House is considering. Healthcare insurance industry officials told the National Underwriter the provisions were left out because the Senate parliamentarian ruled that including such a provision would not comply with the so-called Byrd rule.

    In the face of these facts, that statement was made with a gusto that was scary because he betrayed no hint he knew he was at the least playing fast and loose with the truth.

    So I don't blame Kucinich, I feel sorry for him and forgive him. It is those who are engaging in a level of deception and predatory behavior, of which emotionally blackmailing Kucinich to publicly humiliate himself is just a minor effect, who we need to be concerned about and expose to much scrutiny, not give our support for this deception of reform.

    That's starts by defeating this bill. It is not the start of anything good. And the benefits for working and poor people are not close to what is being said by low-information people like Steve Novick uncritically repeating what other people who are equally low information repeating the talking points that the stalking horses for the insurance industry proponents say.

    I'll leave you with three other statements by Obama today, with an intervening statement he made on Fox, (and which I would have missed if it weren't in a video clip on the WaPo website, sometimes the MSM actually, accidentally, does something good:

    So we’re going to eliminate wasteful taxpayer subsidies to insurance companies.

    We have incorporated the best ideas from Democrats and from Republicans into a final proposal that builds on the system of private insurance that we currently have. The insurance industry and its supporters in Congress have tried to portray this as radical change.

    From the WaPo/Fox clip just two day's earlier:

    When you talk about 1/6 of the economy. This is one-sixth of the economy that right now is a huge drag on the economy. Now we can fix this in a way that is sensible, that is centrist. I have rejected a whole bunch of provisions that the left wanted that, are, they were very adamant about because I thought it would be too disruptive to the system

    Yet he then has the audacity to claim

    That’s our proposal: toughest insurance reforms IN HISTORY, one of the biggest deficit-reduction plans IN HISTORY, and the opportunity to give millions of people -- some of them in your own family, some of the people who are in this auditorium today -- an opportunity for the first time in a very long time to get affordable health care.

    This at least is true:

    It’s a debate about the character of our country -– (applause) -- about whether we can still meet the challenges of our time; whether we still have the guts and the courage to give every citizen, not just some, the chance to reach their dreams.

    But the question is whether the character of our country is that approaching psychopathy as we see acting out right now. It's scary that it's low-information Democrats like Steve Novick and Bill Bradbury who are some of the inciters of the mindless, low-information Democratic mob who just want to see a win, and in their minds, hopefully one that really humiliates the "other side". That, of course, would be the working people and the small number of thoughtful leaders on the "other side" who are needed to move the other changes forward of which this permanent entitlement for the private insurance industry is supposed to just be the start.

  • Kurt Hagadakis (unverified)
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    On this one, you sound to me like a party hack.

    Nooooo....

    It's funny that if you google images of Kitzhaber, you get pictures of Novick and Chisholm as well.

  • Barry Deutsch (unverified)
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    Five points in favor of Obamacare

    1) The purpose of health care reform isn't to screw over private insurance companies; it's to provide more affordable health insurance to millions of Americans who lack health insurance, and to open up eligibility for Medicaid to millions who can't afford even subsidized health insurance.

    2) It'll be better than the status quo (follow that link if you want to be pissed off) -- a lot better.

    Will it be better than single-payer? No, it won't be. But no one has a realistic plan for turning single-payer into law in the US. We don't have a choice between Obamacare and single-payer; we have a choice between Obamacare and the status quo.

    3) Thousands -- maybe tens of thousands of Americans die every year for lack of health insurance. We can't wait until we can pass a perfect health care reform. We have to pass this while we can, and then work to make further reforms in the future.

    4) Obamacare doesn't outlaw private insurance companies. But it will hurt them, which is why - like the so-called "pure" lefties -- the insurance companies are trying to kill the HCR bill.

    5) According to the CBO analysis, Obamacare will put $466 billion in the first ten years into subsidizing insurance for working and middle-class households; $434 billion into expanding Medicaid and Children’s Health Insurance Program (CHIP); and 32 million currently uninsured Americans, will be insured.

    If being a "pure leftist" means being against all that, then who wants to be pure?

  • Details Count (unverified)
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    Barry Deutsch apparently is another of those low-information supporters so common in the NW who repeat superficial talking points about the bill that depend on glossing over the facts.

    1)The purpose of health care reform isn't to screw over private insurance companies; etc.

    Obama today said this bill is not about health care reform, it's about protecting the insurance companies from disruption. And we know that's true because the CBO said this bill will leave over 23 million non-elderly uninsured. They don't even address how many people will still be underinsured. Those who end up with private insurance --- the specific benefits are not specified in the bill, by the way --- still will not necessarily have access to health care because doctors are not required to accept any patient. As many don't accept Medicare and various private insurance plans right now. The expected rate of inflation in health care, especially now that the rate control mechanisms have been stripped out, means there is no factual basis for arguing these will be policies worth anything to anybody or that doctors will accept patients with the insurance plans they can actually afford. Limits on out-of-pocket expenses, lifetime caps, and all the rest, only apply for covered benefits, not any medical need, and only if one actually finds a doctor with whom one is comfortable who accepts the insurance one has.

    2) It's better then the status quo, etc.

    This, and 1) are simply the argument companies make for exploiting labor in developing countries: It's better than they would have otherwise. In fact, that is a shameful excuse for diverting a windfall of billions into insurance companies pockets because it's much worse then everyone deserves and could have if not only protecting, but in fact creating a windfall for the insurance industry weren't one of the top objectives of this bill. And don't forget, Obama also agree to protect the profits of the private, for profit hospital industry by making a deal to actual stop the public option even as he was publicly claiming he was fully supportive of the public option. This was all about making deals with the health care of Americans being what was traded off, creating winners and losers --- most notably that 23 million uninsured.

    3) Thousands -- maybe tens of thousands of Americans die every year for lack of health insurance. We can't wait until ... (etc).

    And for the next four years waiting is exactly what we will boing and people will continue to be die because they are uninsured. Table 2 of the CBO report shows that the number of uninsured isn't scheduled to change until 2014 and the projections starting that far out are not quantified as to margin of error, expectations of health care inflation which could reduce the number of people who can be subsidized, etc. We could instead be putting pressure on Congress, but the low-information defenders of this bill are in fact condoning the continuation of that tragedy for uncertain benefit to the people in 2014, while delivering tangible short term benefit and radically improved long term business prospects for the health insurance industry, the private for-profit hospital industry, and pharma.

    4) Obamacare doesn't outlaw private insurance companies. But it will hurt them, which is why - like the so-called "pure" lefties -- the insurance companies are trying to kill the HCR bill.

    As a documentary a few years ago pointed out, if corporations like insurance companies, which the Supreme Court recently gave the some of the rights of people, actually were people, they would be clinically diagnosed as psychopaths. The fact that a psychopath is not satisfied with an obscene windfall that results in higher costs to us all for less health care for us all, including leaving 23 million underinsured, and greedily, maniacally, wants even more, is not proof of anything. And to use that as argument in an attempt to smear "so-called 'pure' lefties" is truly morally repugnant.

    5) According to the CBO analysis, Obamacare will put $466 billion in the first ten years into subsidizing insurance for working and middle-class households; $434 billion into expanding Medicaid and Children’s Health Insurance Program (CHIP); and 32 million currently uninsured Americans, will be insured.

    And, as noted 23 million will be left uninsured which makes that 32 million number look much less impressive. Moreover, it exposes those who misrepresent that 32 million number as truly intellectually dishonest. So the question is not how much is being spent, but how poorly it is actually being spent because so much of it is a windfall for the private health insurance, for-profit hospital and pharma industries, rather than buying more and better health care for everyone including the 23 million left uninsured who are being traded off as bargaining chips.

    By the way Barry Deutsch, is your argument why the Oregon delegation should still vote for this abomination if the Medicare disparity which is having real consequences for seniors isn't addressed?

    And do you still say the bill should be passed if the late night horse trading to get the Stupak bloc's votes results in the restoring the Stupak language that make women's reproductive health care the only medical care specifically not covered by any of the supposed reforms of the insurance industry AND which is not subsidized in any way, and therefore will disadvantage poor and working women most. Do you criticize those in the so-called pro-choice bloc who have said tonight they WILL take the bill down if that happens (although we shall have to see if they carry through any more than other supposedly progressive blocs.)?

    We have a choice between Obamacare and the status quo.

    We have a choice of telling Congress we won't accept this outrage that demeans the right of every person to the most and best health care we could deliver if we weren't wasteful diverting billions into the pockets of the private insurance industry, and we will vote them out if they don't actually do the right thing. For instance, allow everyone to buy into Medicare --- we don't owe a corrupt private health insurance anything. And since the real benefits don't kick in until 2014, this bill mainly is to provide political benefits, maybe, for Democrats in the 2010 and 2012 elections who have delivered the goods for the insurance industry, the hospital industry, and pharma who they really want to represent.

    Rationalizations such as we've seen offered here that in large depend on either not knowing or not honoring the facts by framing them in a deceptive and distorted way, typical of the corrupt Democratic leadership making them and low-information supporters (many of the self-indulgent intellectually challenged "creative class") mindlessly repeating them, are truly morally bankrupt. The real disgrace is how they are offered as the "moral" argument for the bill. Especially with a immoral mandate we all pay tribute to the insurance industry like serfs rather than give us the option of buying into Medicare to contribute to the common good.

  • (Show?)

    Nate Silver over at 538.. "The progressive bloc failed on health care not because of any deficency but because their bluff was too transparent -- they claimed to be willing to wager enormous stakes (health care reform) to win a relatively small pot (the public option). That would have been beyond the capacity of any poker player - - - or activist -- to pull off."

  • Bluecollar Libertarian (unverified)
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    There have been some who question the complaint that people die from the lack of insurance. Some have even suggested that the number is near zero. However recent studies put the number who die from medical errors and hospital infections at around 200,000 annually.We also know that very few people who are injured ever collect any compensation.

  • Kurt Chapman (unverified)
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    The current wondeful prouncements from dems in DC regarding healthcare are pure bunk.

    At 54, I actually pay attention when I get my annual Social Security Statement. So, what's up some might ask.

    A year ago the cover statement advised that the trust fund would begin getting tapped into in 2017 and would be exhausted (depleted, empty, gone) by 2041. Here we are 12 months later and the fund now will be dipped into a year earlier (2016) and depleted, exhausted, gone 4 years earlier, by 2037.

    Congress has known about the Cocial Security Trust Fund issues for at least 15 years and done nothing. They have known about Medicare and Medicaid Trust funds that will be exhausted even sooner and done nothing. Yet, this same august body wants us to now believe that they can adequately finance and manage healthcare?

    I have a birdge in Brooklyn for sale.

  • Bill Bodden (unverified)
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    "Obama today said..."

    Whatever Obama said and whenever he said it, it should be regarded with the greatest skepticism.

  • Details Count (unverified)
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    paulie wrote:

    Nate Silver over at 538.. "The progressive bloc failed on health care not because of any deficency but because their bluff was too transparent -- they claimed to be willing to wager enormous stakes (health care reform) to win a relatively small pot (the public option). That would have been beyond the capacity of any poker player - - - or activist -- to pull off."

    (This comment is a criticism of Silver, not paulie)

    Of course this is a meaningless statement because "public option" is a undefined term in it. If the "public option" is a full blown single payer plan as groups like PNHP advocate,, or even a Medicare buy-in that keeps billions out of the hands of the insurance industry as those who understand how to use the market force for the actual benefit of the people advocate, the "pot" is power and control in our society. The pot is enormous and that's why the fight has actually been so vicious, to the point supposed "progressives" have reduced themselves to ganging up and destroying people like Kucinich who could have changed who won the pot.

    The truth has little to do with Silver's ex-poste facto framing which reads the evidence as needed to fit the theory, the evidence being whatever definition of "public option" is needed to support his rambling theory, rather than actually propose the theory based on the evidence.

    The evidence is that those who've taken to calling themselves "progressives" and Blue Oregonians and the Democratic establishment are an indisputable example, don't actually stand for much of anything, much less solid core values for which they are willing to do the actual hard work and fight to achieve. Instead they have become the mindless, low-information mob cheering on "their" feckless Democratic standard bearers in mirror image to the mindless, low-information mob cheering on their feckless GOP standard bearers. And even that conflict is breaking down into general chaos as mindless conflict always do as events get out of control of whoever stoked the mob for their own selfish reasons.

    When the Soviet Union fell in the 80's astute observers pointed out the US as we knew it had also destroyed itself in the process, it was just going to take a little longer for the corpse still animated from random nervous action to finally fall lifeless to the ground. Of course that is what we are now seeing in the still unresolved worldwide financial crisis.

    The same can be said of the GOP and the Democratic Party that more astute observers pointed out. The GOP pretty much destroyed itself by the middle of Bush II, but the Democratic Party sold it's soul and destroyed itself in over the same preceding 20 years and now the zombie is finally falling to the ground. Supporters in fact admit as much in the reason they really give for this corrupt, immoral health bill, that they have to pass it to win in November. And by making deceptive and sometimes outright false statements about the pittances they are throwing to poor and working people as pawns in their strategy to keep control of that pot of power and wealth.

    If this bill that mandates tribute to the private insurance industry passes, and in no small reason due to the morally abusive way advocates are acting now, the Alien movies provide a nice graphic picture of what that means for us: The predatory parasitic monster that rips out of the chest of the walking dead Democratic Party in November will join the predatory, parasitic monster that ripped out of the chest of the walking dead GOP to prey in ever more fear-inducing ways on poor and working people in this country.

    Those are the real stakes, and self-aggrandizing hucksters like Silver are part of the problem.

  • Bob Tiernan (unverified)
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    Steve Novick:

    even though the bill requires us all to buy insurance in the ugly private insurance market

    Bob T:

    Do you ever take off those lenses of yours? Are you capable even once of acknowledging that yes, government has helped create the version of a health insurance system we've had for many decades?

    What would things be like now had government not caused it to grow and morph into what it is, starting with wage controls during WWII and followed by all of the privileged legislation that encouraged and fostered the current system at the expense of the ability of individuals and markets to drive the system?

    Mandated coverage for thousands of items make insurance policies spendy, but are these items included in policies because the insurance companies want you to have a $1,000 monthly policy payment, or does government have anything at all to do with the mandated coverage of a large number of items? Why would government want a system in which people could cherry-pick coverage items and pay less for the policy? I don't particularly like the insurance companies when it comes to medical issues (unlike auto insurance, which would be triple the price if government micromanaged it the way they do medical insurance), but all they're doing is what the government wants them to do in the end.

    Oh, hey Steve, what would DVD players cost if government provided them? Would $29 players be available?

    Bob Tiernan Portland

  • Bill Bodden (unverified)
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    Recommended videos on line:

    Kucinich and Nader debate health care at democracynow dot org on March 18th.

    Among the points Nader makes is that other nations, such as France and Germany, have per capita expenses that are half of ours but they provide more and better care. These nations have strong government components in their administrations of health care. In the Year 2000 report from the World Health Organization the table for health attainment and performance France was first, German was 25th, the United Kingdom (heavily government) was 18th, and the United States was 37th. Given the increases lately in health costs here in the U.S. we will probably be 40-something on the list by now.

    Jonathan Gruber, Harvard economist, on C-Span at http://www.c-spanvideo.org/program/292478-1. Among the points Gruber makes is that this bill is an insurance corporation friendly bill.

  • Details Count (unverified)
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    Bob T. wrote:

    Mandated coverage for thousands of items make insurance policies spendy, but are these items included in policies because the insurance companies want you to have a $1,000 monthly policy payment, or does government have anything at all to do with the mandated coverage of a large number of items?

    Actually this is an example of where there is half-truth on the other side, but full argument hinges on just that half truth and is contradicted by the other half truth.

    The half truth is that government micromanaging of benefits by technocrats does add unnecessary costs. It is going to get much worse with this bill, and particularly due to the mandate, which relieves elected officials of the responsibility to do anything except whip up mindless fervor in their base and put pressure on the technocrats they defer to (like the CBO) to do whatever it takes to cook up numbers and apparent results that help them do that. Bob T. and the Republicans are right on point and it is to the shame of our side for not admitting that as part of the political dialog. Of course they know about this because they do it too.

    The untold truth, however, is that so long as we have a corporate system that tries ever more to externalize risk in the way corporate America does ("too big to fail" being a popular culture manifestation of that), that risk has to be managed through ever more regulation to try to minimize destructive effects of risky and irresponsible selfish business behavior on the American and world economy. That's what didn't happen since 1980 and that's what led to the credit crisis that started in 2008 whose consequence we will continue to face for the next decade.

    It is only by not admitting this that too many in Bob T's camp reason to false conclusions. (Although Bob T doesn't say enough in his post to lay it on him in this response.) When both of those truths are taken into account, it becomes logically unavoidable a national health insurance system is the economically most efficient solution in a market economy. That is, remove the inefficient, market-distorting, artificially introduced and sustained intermediary, the private insurance industry, and concentrate the buying power of the consumer (the public) into a single entity that has market dominance. At the same time, because that enormous unitary buying power is subject to the direct political control of the people, who right now see through the lies about this health care reform, the nature of that plan will reflect the actual wishes of the people to the extent they care, rather than to the independent selfish interests of the industry and politicians beholden to it.

    Of course, this also is by far the best solution for small businesses that Republicans and corporate Democrats masquerading as real Democrats claim to care so much about. Small business owners need to concentrate even more on their core business competencies in these tough economic times. And they need to not have to worry about competing for the best people as partners and employees on the basis of health care benefits people really do care about, but whose price and quality the business owner can't control.

    So Bob T. I acknowledge that component of your truth. And those here who don't ought to be ashamed of themselves. But now I want to know, after this plan if passed fails, how people like you would propose to work with those you see in a cartoonish way on the other side, but who do recognize the moral depravity of this proposal? How do you respond if they bring that truth to the table, when this entitlement program for the insurance industry fails and perverts our economy and society even more? Or do you just oppose regulation to manage the risk to our economy, and therefore to working and poor people, but welcome corporate welfare?

    I ask you because there is ample reason to hypothesize that the result of this reform will be even more division, conflict, and chaos then today. And that will make it even harder, not easier, to solve the problem of out of control health care cost causing diminishing access by all to needed health care then it is today. Supporters of this bill who claim with their mindless denialist rationalizations about how this is just the start and improvements will be made along the way are low-information idiots.

    Division, conflict, and chaos is exactly what those of predatory nature like the private insurance and finance industries who have no moral compunction at all turn division, conflict, and chaos to their advantage to accumulate more power and wealth.

    Is the GOP planning and willing to launch a class action suit against the mandate in Oregon? Our Constitution has even stronger "first amendment" rights, which have been ruled to include protection against forced association, then in the US Constitution. MIght make for some very interesting political realignments.

  • Barry Deutsch (unverified)
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    I'm having an exchange with a left-wing opponent of the Health Care Reform bill (aka Obamacare) here on BlueOregon. But for some reason, BlueOregon won't let me post. So I'm posting my response here instead.

    Barry Deutsch apparently is another of those low-information supporters so common in the NW who repeat superficial talking points about the bill that depend on glossing over the facts.

    I wish you wouldn't get insulting; I don't think it adds anything to the discussion. When your arguments are solid, there's no need for personal attacks.

    Obama today said this bill is not about health care reform, it's about protecting the insurance companies from disruption.

    I frankly doubt this is true. Do you have a link to Obama saying this?

    And we know that's true because the CBO said this bill will leave over 23 million non-elderly uninsured.

    It's true, this bill "only" insures 32 million. The remaining 23 million are people who will choose to pay the mandate penalty rather than buy insurance. But at least if these uninsured have a critical need for insurance, they'll then be able to buy into the system -- under the status quo, people who can be insured but choose not to, are turned down by the private insurance companies if they find themselves urgently needing medical care.

    The only thing that would cover 100% of Americans is single-payer. But single-payer is not going to happen in the US in a single step, anytime in the next two or three decades, and maybe not ever.

    If you're saying that no health care reform that fails to cover 100% of the uninsured is ever acceptable, then you're saying we can never have health care reform, ever. You're saying that the 32 million this bill would cover should remain uncovered, forever.

    Those who end up with private insurance --- the specific benefits are not specified in the bill, by the way

    "Specific" benefits? No. But the general scope of insurance under the health exchanges is defined in the bill; all such private insurance must include, at a minimum:

    (A) Ambulatory patient services. (B) Emergency services. (C) Hospitalization. (D) Maternity and newborn care. (E) Mental health and substance use disorder services, including behavioral health treatment. (F) Prescription drugs. (G) Rehabilitative and habilitative services and devices. (H) Laboratory services. (I) Preventive and wellness services and chronic disease management. (J) Pediatric services, including oral and vision care.

    That's a direct quote from the Senate bill; you can find it here (pdf file), on page 105.

    Note that under the law, all members of Congress and their staffs would have to buy their insurance from the same health exchanges. Do you really think that Congress would pass a law requiring Congress and their staffs to buy lousy insurance?

    Under this bill, 32 million currently uninsured people, would be able to buy insurance the same way Harry Reid does. That's not a bad thing.

    As many don't accept Medicare and various private insurance plans right now.

    The large majority of doctors do accept Medicare, actually. And HCR increases Medicaid reimbursement rates, so presumably that will increase the percentage of doctors who take new Medicaid patients.

    That said, let's say that only about 55% of doctors will take new Medicaid patients, and 75% new Medicare patients. If I'm someone who's broke and can't afford to see a doctor, I'm far better off if this bill passes and I can get on Medicaid -- which means that about half of all doctors will see me -- than I am if this bill fails, and I remain too broke to see a doctor at all.

    Are you saying that the only acceptable law is one that will force doctors to accept all patients and all insurance plans, against their will? Do you have any realistic plan for passing such a law over the opposition of the AMA? (The AMA is a far more powerful lobby than the private insurance lobby).

    Health Care Reform is a good bill, but it's not a bill that solves every imaginable problem with the health care system under the sun. You can go on forever saying that this bill doesn't make everything perfect. But we're still better off passing this bill and then trying to get more in the future, than we are if this bill fails and we're starting out again with nothing.

    Medicare didn't make everything perfect, either. But it was a vast improvement over the status quo before Medicare, and for that reason it's good that Medicare passed. The same is true of Health Care Reform.

    And for the next four years waiting is exactly what we will boing and people will continue to be die because they are uninsured. [....] We could instead be putting pressure on Congress....

    Four years is better than 15 years, which is about how long it has taken, historically, for Congress to try again after each health care failure.

    The Democrats have an unsustainable majority in Congress; it's guaranteed that they will be losing seats this November. If this is the best health care reform the Democrats can do when they have large majorities, what makes you think they'll be able to pass a much better, more comprehensive overhaul with a smaller majority?

    Or do you think the Republicans are going to pass something better when they're in the majority?

    There will be no next chance anytime in the next four years. "Pure" lefties like you have been "pressuring congress" for my entire life; have you delivered universal care yet?

    The real world legislative process is messy and full of compromise. A compromised health care bill isn't perfect; it doesn't deliver all its benefits until 2014 (although some benefits would happen right away), it doesn't cover 100% the way single payer would, it doesn't force doctors to accept patients they don't want to accept, and it doesn't eliminate big corporations that make profits from health care.

    But the perfect, pure health care plan -- achieved in a single step, rather than through gradual improvements and compromised -- is much worse than that, because it will never exist outside of your imagination. I'd rather have health care -- even if imperfect -- than have what you'd offer me, which is a chance to remain pure and die prematurely for lack of health care.

  • Barry Deutsch (unverified)
    (Show?)
    I'm having an exchange with a left-wing opponent of the Health Care Reform bill (aka Obamacare) here on BlueOregon. But for some reason, BlueOregon won't let me post. So I'm posting my response here instead.

    Whoops. Obviously, I gave up on posting here (because for some reason the software wasn't letting me), and posted on my blog instead. Then I decided to cut-and-paste from my blog and posted here instead -- and suddenly it worked, and I had stupidly left that intro in.

    Apologies to all for the messiness.

  • Bill Bodden (unverified)
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    "Note that under the law, all members of Congress and their staffs would have to buy their insurance from the same health exchanges. Do you really think that Congress would pass a law requiring Congress and their staffs to buy lousy insurance?"

    I have the Federal Employees Health Benefit Plan (FEHPB) that people in Congress have and am grateful for it, but it has severe limitations and comes up very short when compared with plans in Western Europe. It's not a lousy plan, but it's not anything to brag about.

    Re the comments about Kucinich and other "progressive" Democrats voting yes on this House health bill: To Kucinich's credit, he fought a good and long fight for real health care reform - unlike other Democrats claiming to be progressive but who surrendered after the first skirmish.

  • Patrick Story (unverified)
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    My personal opinion: I have already been put on notice by my doctor's accountant that he may soon begin dropping Medicare patients (like me) because we are "like welfare patients" given Oregon's low reimbursement.

    Do I want DeFazio to vote "No" because of the existing crazy-quilt of unequal Medicare payments to the different states? I fervently hope he ultimately will vote "Yes" or he will risk being "primaried." I hold out this hope because someone very close to me is a breast cancer survivor and also faces unemployment. The status quo is not acceptable to me. It's personal.

  • Details Count (unverified)
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    Uh Patrick, you're obviously one of those people who don't have a clue what you are even saying, so let me give you a chance to un-embarrass yourself:

    Your say your doctor's accountant is telling you this:

    may soon begin dropping Medicare patients (like me) because we are "like welfare patients" given Oregon's low reimbursement.

    Are you aware that Medicare is not an Oregon program but a Federal program?

    Do I want DeFazio to vote "No" because of the existing crazy-quilt of unequal Medicare payments to the different states? I fervently hope he ultimately will vote "Yes" or he will risk being "primaried." I hold out this hope because someone very close to me is a breast cancer survivor and also faces unemployment.

    If the bill passes with the current disparate Medicare reimbursement rate, you will be dropped. Moreover, unless the person close to you is rich, if this bill passes in it's current form, she very possibly will be in the same situation for one or more of the following reasons: First because many of the changes don't take effect until 2014. Second, because if she is eligible for Medicare she will be as screwed as you are if DeFazio (and Schrader) are not successful. And third, if she is not rich and not eligible for Medicare, either she will be paying a lot for private insurance (in four years) and/or may still have trouble getting a doctor depending on what kind of public insurance or publicly subsidized insurance she can afford.

    So if it really is personal for you, and you want to play this kind of game of emotional chicken, you are irresponsible and dishonest unless and until you can point to what specifically in the bill is going to actually benefit her, and how, to prove your point.

    Otherwise, how dare you be so arrogant and disgusting as to imply this is not personal for anybody who opposes this welfare for the private insurance industry that uses the health and welfare of our friends and family members as bargaining chip. I have numerous family and friends who are cancer survivors with unknown prognosis, and this bill is an insult and danger to all of them. And I say that because, unlike you, some of us have actually paid attention to the true details and how that will play out in the experiences they are having with the medical system.

  • Bill Bodden (unverified)
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    "Do I want DeFazio to vote "No" because of the existing crazy-quilt of unequal Medicare payments to the different states? I fervently hope he ultimately will vote "Yes" or he will risk being "primaried.""

    Regardless of what happens, DeFazio is not, and certainly not the only one, to blame. As far as Congress and the White House are concerned, those who have held office there over the years and have prostituted themselves for campaign donations from the health care industries are the primary culprits. DeFazio, as was Kucinich, is in a predicament now. Does he fight for what is right or does he go along with some third or fifth rate plan the nation is going to be stuck with for years to come?

    Kucinich has said that he will continue to fight for the plan the nation should have. I don't question his sincerity, but lotsa luck on that. Most of the 30 million who didn't have health care but will now receive it will likely drop out of the fight and leave the remaining 20 million still left out to sink or swim or die unless, as is very likely they find the insurance companies will prove to screw them over as they have millions of others in the past.

  • Details Count (unverified)
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    After this smart aleck typical passive-aggressive Oregonian remark:

    I wish you wouldn't get insulting; I don't think it adds anything to the discussion. When your arguments are solid, there's no need for personal attacks.

    Frankly, what you believe adds anything to the discussion is irrelevant.

    In response to this example of a typically "bluish" Oregonian, low information, passive-aggressive, in-your-face challenge:

    Obama today said this bill is not about health care reform, it's about protecting the insurance companies from disruption. I frankly doubt this is true. Do you have a link to Obama saying this?

    All you are going to get is what you actually deserve, not what you egotistically think you deserve:

    You obviously were too lazy, and too disrespectful, to have read further up in the same thread before opening your uninformed mouth.

    If you had, you would have found a direct quote of Obama's comments on the Fox clip the WaPo posted a couple of days ago:

    When you talk about 1/6 of the economy. This is one-sixth of the economy that right now is a huge drag on the economy. Now we can fix this in a way that is sensible, that is centrist. I have rejected a whole bunch of provisions that the left wanted that, are, they were very adamant about because I thought it would be too disruptive to the system

    You would also have found a direct quote of Obama's speech to GMU yesterday:

    We have incorporated the best ideas from Democrats and from Republicans into a final proposal that builds on the system of private insurance that we currently have. The insurance industry and its supporters in Congress have tried to portray this as radical change.

    Therefore you obviously had no defensible, much less respectable, basis for this:

    I frankly doubt this is true.

    except the typical low-information egotism of those who repeat talking points in their support of their bill. And you hadn't even bothered to read be polite enough to read what was already written. You have little of merit to add to the discussion because the rest of your comment. Try learning to not use the "I" pronoun if you want to have a serious discussion that connotes respect for the subject matter, intellectual integrity, and the other person.

    You pretty much end your empty comments with this incredible assertion:

    Medicare didn't make everything perfect, either. But it was a vast improvement over the status quo before Medicare, and for that reason it's good that Medicare passed. The same is true of Health Care Reform.

    No, there is a huge difference between the two of which a low-information person such as yourself obviously hasn't the first clue:

    When Medicare was passed it was setting us on the right path to further reform away from what at that time was a system based purely on a corrupt (if less powerful) predatory private insurance system.

    And because of that, those who want to benefit the private insurance industry, have been trying to undermine it ever since. That includes a lot of Democrats who are also making the kind of deceitful arguments you have mindlessly repeated here.

    This bill sets us on path in directly the opposite direction with the explicit, stated intent of dramatically subjugating us to a much more powerful, much more predatory, parasitic private insurance system that is now in league with an even more corrupt Democratic and Republican leadership.

    So your assertion:

    The same is true of Health Care Reform

    is as uninformed and completely wrong as your first assertion.

    You have a long way to go before you show any signs of the true wisdom and knowledge needed to actually have something to offer in a debate such as this. Just because it's your opinion counts for nothing.

  • Details Count (unverified)
    (Show?)

    Do I want DeFazio to vote "No" because of the existing crazy-quilt of unequal Medicare payments to the different states? I fervently hope he ultimately will vote "Yes" or he will risk being "primaried."

    And by the way Patrick, I can assure you if DeFazio votes "No", it's because he will actually be voicing the position of his district. If Democrats want to primary him, it will, and should, open a battle in the party statewide that almost certainly will split the Democratic party into 2 minority factions, as it should.

    The candidate most likely to have his 2010 campaign ended in the primary as a direct result is Bradbury, who not only doesn't seem that bright, and who, to score political points, prematurely took a public position in support of the bill that basically told Oregonians he didn't care about the Medicare disparity. He needs votes from DeFazio's district where he already is none-too-popular. He would either have to admit he and his low-information supporters, which includes a heavy PDX-area component, were wrong with the electoral damage that entails. Or he would have to defend his position in what would be a blatant a passive-aggressive attack not only on DeFazio, but on the very voters of the district he needs that support DeFazio's position. He'd also have problems with Schrader and his district.

  • Tim McCafferty (unverified)
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    I have been a debt collector of medical debts since March of 1984. I have watched as incrementally the insuracne companies tightened the expenditures on insured's benefits until it was the myth of healthcare we have today. They have created a virtually flawless business model that demands huge monthly premiums from everyone, while deminishing the claims for the insured's benefits while they are in the greatest need, and most vulnerable. The reason they got insurance to begin with!

    I find arguments that some make that 85% of America like their insurance as is and would not want government control of our healthcare to be just distructive. I think the way to rebut such arguments is to explain that your insurance company already has a exact amount your health care should cost them until it does not. If you believe that your insurance company is going to be with you through out a serious, continuing illness, your diluting yourself.

    When health insurance was a employer mandate and formed insurance groups of extended coverage their was a time when charges for care was not so expensive, seeing a doctor was equivolent to one less trip to the butcher this week, and our government had hospitals that would always be there, or we thought.

    We have a method of delivering health care that defers castrophic medical care to the government. The extended medical care of their insured to the government, and all manors of medical expenditures to us. The insurance companies profit margin demands their cancelling of coverager, and a quarantine from continued coverage by labeling the insured as a "pre-existing condition," the true stigma of our day.

    Medicare was far from perfect when it started, but it started. Today we can restore it's solvency, it's future with a bill that will have to be improved as we go.

    Let's atleast start from here, and see if we can bring a day that American families will no longer rely only on income status to be the only real factor in their survival.

  • rdurig (unverified)
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    The health care director of the Cato foretasted -- Obamacare Would Increase Deficits by $59 Billion

    His quote

    "Then there’s the additional $208 billion that Democrats plan to spend on physicians who participate in Medicare. Democrats moved that into a separate bill to reduce the apparent cost of the main health care bill."

    This is better than the deem and scheme idea. While Obama hides a very large cost he claims.

    Obama Quote "I will not sign it if it adds one dime to the deficit, now or in the future, period."

    Another evil socialist quote- The great masses of the people ... will more easily fall victims to a big lie than to a small one. Adolf Hitler-

  • john diver (unverified)
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    THE current “health care” bill is a boon to the already corrupt American Insurance Industry! It guarantees it additional billions of dollars in profits, if ratified and signed into law! If the bill fails, the lucrative American Insurance Industry maintains the status quo and does business as usual. It is a win/win situation for the American Insurance Companies! Short falls: the current bill does not address DENTIAL INSURANCE needs! It does not address EYECARE INSURANCE needs! Why? That could lesson profits! What the American nation needs is to do is extend the existing “Medicare” insurance to all Americans! No need for congress to pretend to have to re-invent the wheel here!

  • john diver (unverified)
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    Mr. Stupak only pretends to be anti-abortion!

  • Tim McCafferty (unverified)
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    rdurig?

    I really think you should know that Cato Institute quotes don't carry any weight with this crowd. They were a tool of neo-conservative ideology from their inception, and can only be taken in that context. Just north of worthless.

    Maybe if you tried to do some of your own thinking, that would be good.

  • rdurig (unverified)
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    Hi Tim

    Obama is lying, Omama has cooked the CBO books. If a company said it was profitable and really it lost money, (because an off balance sheet move)the head of the company would go to jail. Everyone knows this is wrong!!!

    Accounting tricks are accounting tricks I could identify many sources. Even the CBO.

    There is an additional $208 billion the government plans to spend on physicians who participate in Medicare. The speaker of the house admitted it when it was found.

    Obama did a very simple accounting gimmick, splitting the bill in two, so he could say one reduces the deficit. And it doesn't. He then is both hiding and denying the truth. Then getting in front of TV and saying:

    Obama two quotes yesterday-

    "I will not sign it if it adds one dime to the deficit, now or in the future, period."

    " The plan will not add to our deficit."

    Everyone with a basic accounting and foresting skill knows it will increase the budget.

    Freedom and justice cannot be parceled out in pieces to suit political convenience. I don't believe you can stand for freedom for one group of people and deny it to others. Coretta Scott King

    I would like a very evil persons quote.

    The great masses of the people ... will more easily fall victims to a big lie than to a small one. -Adolf Hitler

    Obama is our leader, our President, I wanted to support him but he lying, break rules. This is more wrong then anything. Wake up.

  • Tim McCafferty (unverified)
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    I've heard this scurilous assursion that the CBO cooked the books, and say look to the past predictions if you believe that.

    The Republicans said the CBO was cooking the books to show the huge $1.6 trillion in deficits that would result by 2010 were right on the money about the Bush Tax cuts ironically passed by Republicans reconsiliation.

    My bet is that the CBO is just as on the money as they were then!

  • sadengr (unverified)
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    It's interesting that none of the supposedly immediate reforms that affect uninsured adults with preexisting condition includes details of how these laws might be implemented, just vague statements of how they might be funded or penalized for non-compliance.

    I keep hearing people say how impossible it would be to have a single payer system, but no explanation of <u>why</u> it would be impossible to <u>implement</u> such a system. Every "explanation" talks about the disruption to the insurance industry, which is exactly what "reform" is supposed to do. Reform isn't about uneventful evolution or gradual change; it's about compelling changes, not enticing them. Reform requires disruption.

    The only "impossibility" I see is that of getting every elected "representative" to put the health of the all the people of the United States ahead of his own personal political and economic interests.

    I personally believe that many of not most Congressmen start their first terms of office with good intentions and ethical values, and that no newly elected Congressman would object to having his compensation, his rights and his benefits tied directly to those of the people of the United States.

    When they start making decisions based on political considerations, I think that it is because they have become isolated from the real world. This is comparable to what happened during the Bay of Pigs fiasco.

    I have some proposals that would compel (reform) Congress to realign their thinking "to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty" for our posterity.

    1. Eliminate the Congressional group insurance plans. Require the members of Congress to obtain individual health care coverage through the private market as described by the "reform bill the just passed.
    2. Adjust the salaries of Congressmen to 4x the average percapita net income of the population of the United States over the age of 18.
    3. The current requirements for voluntary disclosure of financial and personal communication information assumes that Congressmen are trustworthy and competent. Assume that they are. Using the same logic that went into the authorization of the DHS, they have nothing to fear from being monitored without notice or warrant in the same way as any other citizen might be. Require DHS to monitor every financial transaction and personal communication of every Federal elected and appointed official, and make all information available per the Freedom of Information Act.
    <h2>I think that these proposals are reasonable, and that few Congressmen would be able to publicly defend objecting to them.</h2>

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