HEALTH CARE REFORM TEETERING ON THE EDGE OF FAILURE
There is a growing realization that the public option in the Democrat’s reform package is about to be jettisoned, and that the entire reform effort may be in jeopardy.
President Obama said yesterday:
“The public option, whether we have it or we don’t have it, is not the entirety of healthcare reform. This is just one sliver of it, one aspect of it,” Obama said. “And by the way, it’s both the right and the left that have become so fixated on this that they forget everything else.”
Today, it was moderate Senator Kent Conrad giving his opinion that the public option was dead in the Senate. The significance here is that it appears there are a good half dozen Democrats in the Senate who would be willing to filibuster any reform bill with a public option - enough to prevent the Democrats from breaking that logjam by keeping them short of the 60 votes needed to break the filibuster.
There’s always the Armageddon Option for the Democrats: Using the Reconciliation process, which would mean a simple majority of Democrats in the Senate could pass reform. The problem there is that the Republicans would retaliate as no minority has retaliated in memory.
The rules of the senate make it imperative that a congenial, live and let live attitude permeate its deliberations. The minority has many more options for causing mischief in the senate than the House and if the Democrats act dishonestly by using a parliamentary trick to pass such earth shaking legislation, the business of the senate is likely to come to a near total standstill as the GOP plays their own parliamentary gambits to sabotage the Democratic agenda.
So Reconciliation is probably out and the Democrats will keep negotiating, trying to get something their caucus can live with as well as drag a few Republicans over to vote for reform.
Tactically, the GOP smells blood in the water and many are working hard to see that no health care reform at all is passed. In this, I am reluctantly forced to agree. There is so little that is salvageable in this bill that, as most American’s sense at this point, it would be better to scrap the entire measure and start over from scratch. As I’ve said before, you just can’t get to real, reasonable reform from here. And the sooner they scrap what they have and start over the better.
This country desperately needs health care reform - if for no other reason than to get a handle on the out of control rise in costs. But there are other reasons for reform as well. In many cases, the people who need health insurance the most can’t get it because of chronic or pre-existing conditions. This is a group that numbers in the millions and if you include those who would love to have health insurance but can’t afford it, there has got to be a way to see that these people are covered.
Insurance co-ops may be the answer. They require limited government involvement - seed money, basically - and have the advantage of being able to make their own rules and spread the risk so that those with pre-existing conditions can get the coverage they need. And they promise to be a little cheaper than private insurance plan. But the keys are flexibility and portability. Several different plans can be offered and you can take the policy with you if you move or change jobs.
They aren’t perfect, but a far cry better than a public option in my mind.
The real question would be, if the Democrats fail, would the moment in history be lost for genuine health care reform? I think the desire for Congress to address the problem is still there by the American people. They just don’t want the Democrat’s plan. I am not stupid enough to believe that any further effort at reform will necessarily involve purely market driven solutions. But I can’t believe the Democrats are stupid enough to ignore that aspect of reform.
Simple reforms like allowing insurance companies to sell across state lines, easing rules that insurance companies must include a host of specific mandates in coverages, tort reform, and the aforementioned co-ops would be a good start. It’s not as comprehensive a reform effort as the Democrats are undertaking presently and thank God for that. But it is a reasonable beginning that, along with serious Medicare reform, just might put some downward pressure on costs.
Then, in a few years, we can revisit the issue and gradually, through trial and error, come up with the necessary reforms that would accomplish what we all want; an efficient system that delivers quality care to as many as can reasonably be expected in a nation of 300 million people. What we need is an American solution to this problem, not a Euro-lite bastardization of a system that would probably end up adopting the worst of both worlds.
If the Democrats and Obama fail, there will be much rejoicing by many on our side of the debate. This would be shortsighted and childish. As partisan as the debates can get, it doesn’t obviate the fact that health care reform is a necessity and that both parties have to act like grown ups and be responsible leaders by tackling this issue that perhaps even more than terrorism, threatens us with destruction.
Sadly, it appears that we have a president who just isn’t up to the leadership challenges to get anything done on this issue. By stubbornly insisting on pushing for so much, so soon (and demonizing those who disagreed with him), President Obama has botched it but good. He has stood by and given House and Senate committee chairmen their heads with what even Democrats are saying is minimal guidance. He has failed to energize his own base and get them out to support his reform policies. And perhaps most shockingly, he has failed to exercise leadership in his own party and bring the Democrats together to vote for his ideas on reform.
For his efforts so far, I would give President Obama a D- grade. He is on the precipice of failure at this moment, his fate out of his own hands and in the hands of others.
And that is a position only incompetent presidents find themselves in.
If it’s teetering, let’s give it a little push then, shall we?
Comment by proof — 8/16/2009 @ 3:23 pm
I’ve suspected from the start that the public option was trade goods. It’s not an original idea with me, though I can’t remember who was suggesting it many months ago.
But you’ll notice that opposition is centered almost entirely on the public option.
In the meantime we’ve all more or less coalesced around portability, no pre-existing conditions, transparency, vouchers for the poor, modification of the tax deduction system and tax increases on the well-off and maybe a national as opposed to state insurance market.
I liked the public option because I like more choice rather than less. But I always thought that’s what we’d be willing to give up to get 75% of what we wanted.
So now we can drop the PO, the Blue Dogs can come rushing back and claim victory. We’ll probably get the Maine women, too, and maybe a random GOPer here or there. The bill will pass. It will be the Obama health care reform, it will be arguably bi-partisan.
It will do little or nothing to bring down costs. For which we can conveniently blame right-wing GOP intransigence and scare-mongering. (The Blue Dogs will be forgiven and forgotten.)
Then, in a few years, we’ll add the public option.
Obama doesn’t care who gets credit, or what people say about him. He only cares about what he gets done. He will have gotten done what he needed to get done.
Nothing left to do then but get those death panels up and running.
Comment by michael reynolds — 8/16/2009 @ 3:33 pm
“Seed money”? I’d have to see how much control Obama thinks that seed money cedes to him and the democrats in Congress. I suspect he imagines that it’s a lot. Therefore, co-ops are a public option masquerading as something that Chris Matthews suggested “sounds less socialist.” How about we get the seed money from the insurance companies and the pharmaceuticals, and the federal government keeps its grubby hands out of it? At least if they screw it up, the American people will have a recourse via the courts.
Comment by Anon — 8/16/2009 @ 4:02 pm
“In this, I am reluctantly forced to agree.”
Why reluctant? Why not acknowledge that anything that Pelosi and Waxman and the leftwing Democrats can support will be so awful that the best we can hope for is for the Democrats to incompetently do no harm prior to November 2010 and for their bloated majorities to get cut down so that the threat of bad legislation is greatly reduced.
“Simple reforms like allowing insurance companies to sell across state lines, easing rules that insurance companies must include a host of specific mandates in coverages, tort reform, and … ” whoa nelly … that’s the *McCain* and GOP set of proposals you are talking about. This a pipe-dream until we get a better Congress, and for that, see above.
Best possible outcome:
1. Nothing passes in this session
2. GOP wins Congress in 2010 and the above set of proposals become part of (bi)partisan reform. Obama vetoes and becomes one-terms or passes the conservative reforms and survives a la Clinton with welfare reform.
Probable outcome:
1. Dems pass a hacked-up bastardized health care deform package that satisfies nobody.
2. GOP wins Congress in 2010.
3. Anything good the GOP does is vetoed by Obama. We muddle through until 2012 and dump The One.
Comment by Travis Monitor — 8/16/2009 @ 4:39 pm
“But you’ll notice that opposition is centered almost entirely on the public option. ”
Wrong. There are multiple outrages in ObamaCare.
1. Tax hikes
2. Squeeze on Medicaid will suck state budgets dry (unfunded mandates anyone?)
3. Mandates, Mandates, Mandates - THEY DONT WORK. See Massachusetts. Individual mandate is particularly odious as it amounts to a massive tax hike on self-employed people making $50-$100k and barely scraping by. But the mandate on small business will also KILL JOBS at a time when we cannot afford to lose them.
4. The ‘death consultations’ are just a part of the ‘deathcare’ problem, its the Daschle-advocated boards that will over-rule doctors decisions and mandate/control care. This is building the infrastructure for govt takeover and to deny it is to engage in Orwellian double-talk and ‘trust me’ simplifications.
5. Taxpayer-funded abortions. Sen Hatch caught Sen Mikulski slipping it in. We will have taxpayer funded abortion unless they Reaffirm the Hyde Amendment and stop the backdoor funding of abortions.
6. $10 billion giveaway to union health plans. “Power corrupts”.
the list goes on.
Obama was right. Public Option is “just one sliver” of what is wrong with ObamaCare.
“Obama doesn’t care who gets credit, or what people say about him.”
This is such an obvious and fishy lie, I’m sending it to flag@whitehouse.gov.
Please, all credit goes to him and any dissent is unpatriotic ‘mob’ behavior; you are slandering the Cult-of-Personality Disorder President!
Comment by Travis Monitor — 8/16/2009 @ 4:47 pm
“it doesn’t obviate the fact that health care reform is a necessity”
I call baloney on this meme, which is only convenient for those mindlessly advocating bad ideas.
ObamaCare will make a flawed but mostly working system worse.
It is worse than doing nothing. Ergo, if the choice is ObamaCare or no bill this session, then health care ‘reform’ is NOT a necessity. Most Americans btw agree with me (check the Rasmussen poll).
The ONLY necessity of new laws is same as the Hippocratic oath’s first duty - “Do No Harm”. If only legislator’s would heed that rule!
It is people like you who is going to make America a second class economic power. Refusing to support any reform is tantamount to accepting the fact that health care costs are going to continue to skyrocket out of control and that within a decade, we will be forced to make even harder choices on defense, and other federal necessities that will make us weaker than Canada.
Reform is the only option to avoid catastrophe.
ed.
Comment by Travis Monitor — 8/16/2009 @ 4:55 pm
Send a note of thanks, Rick(you gonad-less wonder!) to Sarah P. for helping lead the parade on this!
I’m a gonad-less wonder and you don’t even have the courage to put your name on your comment?
Bwahahahahahahahahaha…
ed.
Comment by Earl T — 8/16/2009 @ 5:52 pm
Your comment, “This country desperately needs health care reform - if for no other reason than to get a handle on the out of control rise in costs.” is interesting. I do not feel that there is any way to control the costs of health care in this country at the moment except for rationing and that’s not going to happen in my lifetime. It is my opinion that the main cause of increasingly higher health care costs is the American Public. We want it all, we want it now, and we don’t want to pay for it. It’s that simple. When you have a commodity such as health care that has minimal if any restrictions on demand, costs are going to increase. Simple economics comes into play here. The only real restriction is how much of our GDP do we wish to use for health care? If we choose to have unrestricted at any price health care where anyone can walk into a hospital or doctor’s office and obtain any procedure from a brain extraction to a big toectomy and walk out without having to take costs into account, then we as the American Public are going to have to pay a greater percentage of our GDP for that type of service. GDP is a limited fixed finite amount. The outcome is that we will have less money to spend on other commodities such as food, housing, transportation, energy, etc. The American Public doesn’t want that outcome either. Maybe we should impose a health care tax on our exports to make others pay. Sounds like the American way to me. Tax someone else.
Further, as more and more technical and medication advances are made to prolong and improve lives, the American Public’s demand for those services are only going to increase. The American Public does enjoy the latest and greatest in medical care, especially technology. The capital costs of technical advances are enormous.
The American Public is not going to put up with a Canadian or UK style health care system that rations. That thinking is just not in our philosophy. What, the American Public does without.
Obama care is going to solve nothing and increase costs and lower service. It will benefit just a few and will not affect the Elite. Leave it the way it is. In my opinion the American Public does not realize just how good our health care systems is and the benefits that we derive from it. Personally we should all get down and kiss the ground and be thankful for all we have in this world.
Comment by Splendiferous — 8/16/2009 @ 6:08 pm
#7: “It is my opinion that the main cause of increasingly higher health care costs is the American Public. We want it all, we want it now, and we don’t want to pay for it. It’s that simple.”
While I agree that Americans will not tolerate a system of rationing, as odious both to our freedom and our health, I disagree that we have to resign ourselves to an expensive healthcare system and that the American Public is to blame.
There are 3 structural issues, and 3 structural fixes:
1. The American public is not in favor of defensive medicine, which sucks up a good amount of medical costs, and is a result of over-litigious actions against doctors. Solution: Medical tort reform.
2. The ‘we dont want to pay for it’ statement actually should state that ‘we do not pay for health costs directly as we do with other goods’. only a fraction of healthcare costs are direct payer. What IS the way to go is to get more direct payment of medical costs and move away from kitchen-sink style health insurance. If people have to pay a portion of health costs directly, they will act more like rational consumers and less like kids in a candy store. Solution: Allow ‘bare bones’ health insurance, allow getting health insurance across state lines, have ‘healthcare savings accounts.’
3. We choose to have healthcare to cover diseases and the ‘frontier’ of research has been to grapple with more and more challenges. We’ve made great progress, but the ‘cost’ of progress in healthcare is a rampup in how much we spend on care, from expensive neo-natal care to kidney dialysis. In short, technology got us into this fix, and an entirely different set of technologies could be used/applied to greatly reduce the cost of healthcare delivery. Remote diagnosis (imagine getting a consultation by videophone), leverage nursing, posting prices, standardizing medical data, reducing the overhead of hospital stays, less invasive procedures. The list of possibilities is endless. Solution: If we directed some of the $40 billion the NIH spends to the challenge of “reducing direct medical costs”, we could fundamentally change the medical cost equation with new technologies targetted at medical care cost reduction.
Rationing is NOT the way to go so long as it doesnt change this cost equation; It doesnt work as an effective economic principle. Likewise, other bureaucratic solutions will end as failures. Instead, we should focus on tort reform, recasting healthcare in more direct payer ways, and technologies for low-cost medical care. THAT will solve the problem.
Comment by Travis Monitor — 8/16/2009 @ 6:30 pm
Nice try on the spin, Michael Reynolds… try selling that gold-sprayed turd to Chris Matthews, or Olbie… they’ll buy it… nobody here will.
This is pure and simple a disaster for Obama. Chicago politics don’t play well outside of Chicago. Lesson learned? You better hope so, or 2010 will be a 40 seat pickup for this “party in shambles” that you keep trolling, er… commenting about.
Comment by lionheart — 8/16/2009 @ 8:21 pm
Lionheart:
Well, I guess we’ll see, won’t we?
By the way, here’s the opening graf of Obama’s speech on the signing of the health care reform bill:
“I am very pleased to sign this landmark bipartisan legislation today. From this day forward health insurance will be available to almost all Americans. Never again will you hear the words ‘pre-existing condition.’ Never again will you have to fear losing your health insurance when you lose your job. The days of Americans being bankrupted by health expenses will be over. And I have kept my promise to make this bill bipartisan and to avoid any tax increases on the middle class. This bill was not everything we wanted, but it is most of what America needed. And we will revisit the issue as necessary in the future. For now let’s celebrate a great day for all Americans.”
They’ll call it the Ted Kennedy Health Care Reform.
The whole country will breathe a sigh of relief that the fight is over. And the takeaway will be that things are better because of Obama, despite the screeching townhall loons of the GOP.
But don’t believe me. Wait for the poll numbers in a few months.
Comment by michael reynolds — 8/16/2009 @ 9:15 pm
In a MSNBC article Democrats are blaming Republicans for the removal the Public Option!
The Democrats can’t even admit their own failings in putting forward an abortion (pardon the pun) of a health care bill and to save face they are blaming Republican opposition. Are they trying to save Blue Dogs from attacks from the left? Are they trying to set up the Republicans when not one of their votes was needed to pass the bill in either the house or senate?
LOL!
Cowards, the lot of them!
Comment by SShiell — 8/16/2009 @ 9:37 pm
#10: So Obama will lie at his signing ceremony just as he’s been lying at his Pokemkin-village phony townhalls. Fascinating.
The individual mandate and the small business mandate ARE middle class tax hikes. Of course they dont call it that, but they are; business mandate is payroll taxes; income tax reporting with penalties for failure to spend money as spec’d by govt, with fine for failure to do so = taxes.
Comment by Travis Monitor — 8/16/2009 @ 10:26 pm
I’ll bet they will…heh heh heh!
Comment by Surabaya Stew — 8/17/2009 @ 12:41 am
Thank God for incompetent presidents and their hubris, then.
At the end of the day the problem of the uninsured and underinsured will remain. Rather than tackle this actual problem, Obama and the rest of the left-wing cabal opted to try to grab control of a sixth of the economy. That was all they wanted, and when they didn’t get it, suddenly the aforementioned problem wasn’t all the important. Obama and the Democrats not only lack the intellect to govern effectively, they lack all compassion. The town hall voices merely were a reflection of the wrath this failed power grab stirred, and voters will register their anger at the polls against this slimy crew next year and again in 2012.
Comment by obamathered — 8/17/2009 @ 5:01 am
Heh. And coyotes will talk, and snakes will fly. You really are good at fiction, Michael.
Comment by lionheart — 8/17/2009 @ 7:10 am
Lionheart:
I’m flattered you read my book, GONE. Don’t forget, the second one, HUNGER is out now. And LIES comes out in fall of 2010.
And check out THE MAGNIFICENT 12, coming fall of 2010. To a store near you.
Oh, wait, that looks like advertising. Let’s disguise that with some politics so Rick won’t notice:
Republicans eat too much soup!
Comment by michael reynolds — 8/17/2009 @ 8:25 am
But are the town hall voices representative of America? When I look at those protesters, I see that 99% of these folks are white, over 40, and lower/middle class. (Not exactly the Democratic party’s base of supporters.) Were some of these folks disgruntled Obama supporters, he might have to worry about 2012, but I’m willing to bet that practically all of the town hall “angry participants” all voted for McCain or Ron Paul anyway. Certainly they can register their “anger” at the ballot box, but its not as if they weren’t going to vote against the Democrats anyway.
Comment by Surabaya Stew — 8/17/2009 @ 9:03 am
Michael Reynolds:
I did think that was one of my more clever retorts.
And soup? I wouldn’t dare suggest comparing a fellow citizen to a Nazi (upon penalty of banishment by Rick), but are you trying to tell Republicans “NO SOUP FOR YOU”?
I know, that’s pretty weak humor, but I’m supposed to be working, and its tough being creative when you have to keep hitting the “boss” key.
Comment by lionheart — 8/17/2009 @ 11:50 am
“Insurance co-ops” = “Public Option”
The differences between the two are just semantics.
Either option means the government controls health care and that is what very few people in this country wants.
If you want to see ‘insurance co-ops’ at work look at Medicare.
Comment by bb — 8/17/2009 @ 1:13 pm
Let’s see, health care costs keep going up. (R and D = Research and Develpment or Design, not Republican and Democratic.)
Basic problems include new drug introduction and how long that patent is protected. The longer the protection the longer the R and D costs may be amortized and new drug will cost less before it goes to generics and then costs even less. The shorter the protection, the higher the consumer cost, because the Pharma company would like to recover the R and D costs, and will charge what it takes to make that money until generics appear.
If they don’t cover those costs (and make a little profit), then R and D will suffer, and fewer new drugs will come to market. Cap what they can make on new drugs and you essentially cap new drugs from being made in the first place.
New tests? Same basic problem. They need to pay for the R and D or it’s not going to be worth the innovation. Of course, cost avoidance, in the form of malpractice avoidance, may spur the development of new tests for various conditions. That’s not guaranteed, nor can one predict where development might occur. Most malpractice insurance companies don’t own pharmaceutical outfits.
If Obama is squealing about “unnecessary tests” (and there for a while he was), then it is illogical (and purely political) to avoid tort reform. Of course, with politicians like John Edwards, we know why we won’t see “Democrats for tort reform.” Now don’t we?
Comment by David R. Block — 8/17/2009 @ 1:53 pm
I think that we could stand a compromise between the Democratic bill and one written by Senator Coburn (OK), and Representatives Michael Burgess (TX-26), John Fleming (LA-4), and Ron Paul (TX-14).
You would have the lawyers bill and the doctors bill, respectively.
(And I may be missing some of the doctors.)
Comment by David R. Block — 8/17/2009 @ 2:01 pm
“But are the town hall voices representative of America?”
Rasmussen now has over 40% of voters *strongly* opposed to Obama and to Obamacare, and a majority opposing Obama. Very early for ‘The One’ to fall under the crucial 50% mark.
” When I look at those protesters, I see that 99% of these folks are white, over 40, and lower/middle class.”
(A) That’s false generalization (what about that College kid that stumped BHO in Colorado?), (B) that still covers at least half the voters, and surely represents ‘mainstream America’ and (C) How did you detect the ‘class’? The lack of ascots? No Benzes and Jaguars in the parking lot?
Comment by Travis Monitor — 8/17/2009 @ 7:25 pm
Obama will only worry about his ratings when someone other than Ramussen does the polling. It’s well known they have a srtong Republican bias in their numbers.
(A) I plead guilty to generalizing the average Tea Party goer, but I don’t think calling the vast majority of them older is false. (BTW, did you mean the one who worked for the RNC? That’s certainly not your average college kid!)
(B) That’s certainly true, but isn’t this same segment of “mainstream America” thats been against every liberal movement and government action since FDR’s time? (And where were they during the last 8 years protesting government overreach and budget deficits?)
(C) Guilty again; I was just looking at how people in the videos were dressed and how they were talking/screaming, when I made my comment. I didn’t detect any graduate degree holders, millionaires, welfare recipients, non-whites, children, gays, or disabled/sick Americans protesting against health care reform. Did you?
Comment by Surabaya Stew — 8/17/2009 @ 11:26 pm
Not going to engage your argument here - just thought I’d say that I’ve skimmed your last two weeks of posting and am vaguely impressed that you’re at least interested in being constructive. I’m not particularly impressed with the specifics of your ideas on the alternatives, but it’s nice to see someone not offering deliberate nihilism.
Anyone who can see that Sarah Palin has from start to finish been a vapid, hypocritical, sensationalist hack isn’t completely unreedemable.
Comment by glasnost — 8/25/2009 @ 8:15 am