Health Care Reform - Can We Simply Start Over Again Or Is This Our Best Shot?

[TomCADem]

The call of the right wing, and a minority of the left, to start from scratch on health care reform reminds me of right wing efforts to delay progress on climate change due to the need to get certainty on the science of climate change. I see a lot of disengagement and disillusionment with the process, and calls for apathy, rather than action. These calls are aided in no small part by corporate funded attacks on health care reform aided in no small part by propaganda networks like Fox News.

The question I have is do we have the luxury of time? Does health care reform get any easier in the future? Do we take an absolutist all or nothing approach where anything short of single payer is not worth doing? Or, do we get the best reform we can, and continue to fight for improvements in the future?

Personally, I think many folks lose sight of the fact that Medicare, which is often hailed as a great example, was a very difficult fight that spanned five years. Medicare was a sharp compromise form Truman's call for universal health care. JFK/LBJ campaigned on it in 1960. JFK demanded it this year in 1962. It stalled in Congress. LBJ became President in 1963 due to JFK's assasination. In 1965, two years after he became president, LBJ signed it.

Over forty years later, we marvel at the speed of the passage of Medicare, and ignore how it was dramatic compromise from universal health care.

So, I think this is our best shot, and 40 years from now, some other Democratic president may be unfavorably compared with President Obama with future progressives bemoaning how their President couldn't get major legislation passed with the speed and effectiveness of President Obama.

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[treestar]

1. I've seen many posts giving LBJ all the credit

for being such a tough guy arm twister!

yet here it was five years of buildup before he could sign it!

[TomCADem]

4. I Think JFK Is Often Short Changed On Medicare

Medicare seems like a no-brainer. Medical care for seniors. Yet, it took the combined effort of JFK and LBJ over five years to make it happen. The polls from that era are eerily similar to present day polls. Yet, over the course of five years, public opinion turned around.

LBJ was not a superman who started from scratch on Medicare in 1965. Rather, he built on three years of effort by JFK, and two years of effort on his part from 1963 to 1965 to get Medicare passed with a commanding majority in Congress. This long, ongoing effort was impressive in its own right, but would be difficult to replicate today.

Afterall, it has been less than one year, but how many times has President Obama's health care reform efforts been declared dead? Now, can you imagine five more years of debate on health care reform?

[pnwmom]

2. I think this is our best shot -- for now.

And if we don't take it, it will be another decade or even longer before we have a chance like this.

[HowHasItComeToThis]

39. WE NEED NATIONAL HEALTH CARE

NOT INSURANCE ADJUSTMENT

[AllentownJake]

3. Wasted political capital

Should have focused on banking, insurance, and derivative regulation.

Oh well.

[TomCADem]

5. Health Care Reform Is A Waste?

Sixteen percent of our GDP and growing seems pretty significant to me.

[AllentownJake]

7. We shall see

If in 2010 unemployment is still at above 10% yes it was a waste and we will pay for it politically.

There is an equation for recovery

1) Stimulus (though the bill is watered down with a bunch of shit)
2) Regulation or in this case re-regulation

As far as most important issue of the moment, I think economy trumps Health Care.

This bill could have passed in 2010 or 2011.

[TomCADem]

10. Health Care Is The Economy - $6,500 Per Capita

I don't really buy into the Republican talking point that the President should not multi-task, and should spend his time 24/7 on short term stimulus. There will always be a crisis, and hoping for some magical era of peace and prosperity to pass health care reform is wishful thinking. If anything, during such an era, there will be a powerful argument not to rock the boat.

Also, how does our economy recovery if health care costs continue to rise unabated? The auto industry is a perfect example of how the manufacturing sector has been crippled by such costs. The stagnation in real wages during the Bush era is yet another example.

The economy does not trump health care reform. The economy is health care with 16 percent going to GDP. Ignoring health care insures that efforts to stimulate the economy are short lived and temporary.

[AllentownJake]

12. The Congress can't mutli-task

Putting forward a legislative intiative takes time.

From all appearences this is a health insurance bill. I'll hold final judgement till I see the final bill, but I really don't see anything being proposed that will reduce costs significantly.

That being said without regulation of the finance sector there will be no recovery. It is like pissing money into a bottomless pit. Any benefit the government programs will have will be wasted.

What is done is done.

[TomCADem]

16. Health Care Is 16% Of GDP - Can't Multi-Task Is A RW Talking Point

You say "without regulation of the finance sector there will be no recovery." Really? How is regulation of the financial sector stimulative? Indeed, I thought the goal of financial regulation was to diminish the incentives for speculative investments and bubbles. Now, if you want a quick recovery, wouldn't you want some speculation as Bush encouraged from 2002-2006, which resulted in the real estate bubble? Of course, it was short lived, but you appear to be demanding quick results for the 2010 elections.

I am just curious what magical reforms of the finance industry will result in benefits that trickle down to most Americans? Unless, you want to promote speculation, I thought the goal of regulation was to reduce the risk of speculative bubbles.

So, I disagree that the finance industry holds the key to our recovery.

[AllentownJake]

19. How is regulation stimulative?

Easy answer returning banks to their original roles as investors not speculators is stimulative. Allowing a casino to stay open during an economic downturn is a Hoover like policy.

If finance regulations would pass in December 2009 vs. May of 2010 there would be an actual easing of the credit crisis. There has been no easing of the credit crisis, and every report I read reinforces that.

Also reinforcing stability in the American Financial Markets would make the country friendlier for foriegn investment.

Instead what you have is firms taking the money they were given to lend and throwing it into speculative adventures and bankrupting themselves all over again.

More people will lose their health insurance due to unemployment or underemployment as a result of this strategy than will gain in it in a bill that is waiting till 2013 for key provisions to kick in.

The Finance industry caused this mess. You ain't getting out of it till it is reigned in.

[TomCADem]

37. So, Regulation of The Financial Markets Is Stimulative? That Is The Object?

Do you have any cites to Democrats making the argument that financial regulations have a short term stimulative effect? I can understand that over the long run, financial regulation is necessary for our economic health, but stimulative? I would find it facinating to read such an analysis.

The assertions you raise also seem to be more along the lines of long term benefits from financial regulation: "einforcing stability in the American Financial Markets would make the country friendlier for foriegn investment." Really, so if we re-instate Glass-Steagall, for example, foreign investment will come rushing in?


Personally, I think that financial regulation is something that we need to do, but in the short term, I don't see how regulation will have a stimulative effect. Indeed, I personally would be very suspicious of any proposed financial regulations that were supposed to provide a jolt to the economy. But, hey, I am willing to learn otherwise.

[pnwmom]

11. Way back in January, Krugman argued that health care reform should be a key

component of fixing the economy. I think he was right.

http://www.nytimes.com/2009/01/30/opinion/30krugman.html

But helping families purchase health insurance as part of a universal coverage plan would be at least as effective a way of boosting the economy as the tax breaks that make up roughly a third of the stimulus plan — and it would have the added benefit of directly helping families get through the crisis, ending one of the major sources of Americans’ current anxiety.

Finally — and this is, I suspect, the real reason for the administration’s health care silence — there’s the political argument that this is a bad time to be pushing fundamental health care reform, because the nation’s attention is focused on the economic crisis. But if history is any guide, this argument is precisely wrong.

Don’t take my word for it. Rahm Emanuel, the White House chief of staff, has declared that “you never want a serious crisis to go to waste.” Indeed. F.D.R. was able to enact Social Security in part because the Great Depression highlighted the need for a stronger social safety net. And the current crisis presents a real opportunity to fix the gaping holes that remain in that safety net, especially with regard to health care.

SNIP

I agree with administration officials who argue that these financial bailouts are necessary (though I have problems with the specifics). But I also agree with Barney Frank, the chairman of the House Financial Services Committee, who argues that — as a matter of political necessity as well as social justice — aid to bankers has to be linked to a strengthening of the social safety net, so that Americans can see that the government is ready to help everyone, not just the rich and powerful.

The bottom line, then, is that this is no time to let campaign promises of guaranteed health care be quietly forgotten. It is, instead, a time to put the push for universal care front and center. Health care now!

[AllentownJake]

13. In January they were thinking unemployment

would be held to 8% by the stimulus bill. It was an underestimation of a problem or an over estimation of the effectiveness of their planned solution.

[TomCADem]

17. So, Because Someone's Estimate On One Thing Is Wrong, They Are Wrong For All Purposes?

The 8 percent unemployment estimate in January were based before the actuals for the fourth quarter of 2008. Yet, the Republicans happily cite this figure as an all purpose idictment of President Obama's policies. Not sure, how that incorrect estimate, which was an estimate, is relevant to the question of the passage of health care reform.

[AllentownJake]

22. Actually

They had October and November's numbers so that is really a piss poor argument.

It was stupid of the President to attach an unemployment percentage to the stimulus bill.

Stating that the President under estimated a problem or over estimated a solution is reality, it is a statement of fact. It has no political bias.

Will it be used as a hammer in 2010, probably.

[TomCADem]

35. And, how does the unemployment rate estimate in Jan. relate to health care reform?

Specifically, can we really put off health care reform again? I don't understand the leap in logic.

[pnwmom]

29. If you've read his recent columns you know that he still thinks it's a critical

part of stimulating the economy.

[AllentownJake]

30. We shall see

I stand by my opinion that this should have been the third objective after the stimulus bill not the second.

I don't think health care reform is a bad thing, I think that this exact bill could pass in six months or two years from now and since a lot of the provisions are being pushed back to 2013, I don't really see the urgency.

[pnwmom]

33. Many of the House bill provisions would take place immediately.

The need for this bill might not seem urgent to YOU, but it IS to millions of Americans.

TOP 14 PROVISIONS THAT TAKE EFFECT IMMEDIATELY

1. BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE — Reduces the donut hole by $500 and institutes a 50%
discount on brand-name drugs, effective January 1, 2010.

2. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL) — Creates a
temporary insurance program until the Exchange is available for individuals who have been uninsured for several
months or have been denied a policy because of pre-existing conditions.

3. BANS LIFETIME LIMITS ON COVERAGE—Prohibits health insurance companies from placing lifetime caps on coverage.

4. ENDS RESCISSIONS—Prohibits insurers from nullifying or rescinding a patient’s policy when they file a claim for
benefits, except in the case of fraud.

5. EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 27TH BIRTHDAY THROUGH PARENTS’ INSURANCE— Requires health
plans to allow young people through age 26 to remain on their parents’ insurance policy, at the parents’ choice.

6. ELIMINATES COST-SHARING FOR PREVENTIVE SERVICES IN MEDICARE—Eliminates co-payments for preventive
services and exempts preventive services from deductibles under the Medicare program.

7. IMPROVES HELP FOR LOW-INCOME MEDICARE BENEFICIARIES—Improves the low-income protection programs in
Medicare to assure more individuals are able to access this vital help.

8. PROVIDES NEW CONSUMER PROTECTIONS IN MEDICARE ADVANTAGE— Prohibits Medicare Advantage plans from
charging enrollees higher cost-sharing for services in their private plan than what is charged in traditional Medicare.

9. IMMEDIATE SUNSHINE ON PRICE GOUGING—Discourages excessive price increases by insurance companies through
review and disclosure of insurance rate increases.

10. CONTINUITY FOR DISPLACED WORKERS—Allows Americans to keep their COBRA coverage until the Exchange is in
place and they can access affordable coverage.

11. CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM—Creates a long-term care insurance
program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled.

12. HELP FOR EARLY RETIREES—Creates a $10 billon fund to finance a temporary reinsurance program to help offset the
costs of expensive health claims for employers that provide health benefits for retirees age 55-64.

13. COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for a doubling of the
number of patients seen by the centers over the next 5 years.

14. INCREASING NUMBER OF PRIMARY CARE DOCTORS — Provides new investment in training programs to increase the
number of primary care doctors, nurses, and public health professionals.

PREPARED BY OFFICE OF SPEAKER PELOSI – OCTOBER 29, 2009

[Cant trust em]

14. I think that's a compelling argument.

Has Obama taken on too much? Maybe.

I love the work that Barney Frank has been doing though.

[AllentownJake]

15. Barney has been doing a decent job

He's in a difficult position. Most of the members of his committee, both democrat and republican have taken bribes for year from the finance insitutions.

Holding firm on the derivative regulations for big financial firms was a good move.

The exemption for smaller firms may come back to haunt him.

[Cant trust em]

18. CFPA and the dismantling of Too Big To Fail will be huge. nt

[AllentownJake]

20. Don't like it being housed in Treasury

Would rather have it be housed in an independent commission like the SEC or FDIC, but those take time to establish.

More afraid long term it will be more capable of influence of political considerations in the Treasury department. Who knows political considerations influenced the SEC for the past 8 years.

[Cant trust em]

21. I don't think that there's a way to shield everyting from politics.

But it's a valid point nonetheless.

[AllentownJake]

23. I don't trust Geithner

if Volker was at Treasury right now, I'd be more inclined to support it right now, not thinking about future Treasury Secretaries.

[Cant trust em]

24. Geithner was the biggest mistake the administration has made.

I'm pretty supportive of most of what has happened, but Geithner is causing me a lot of second guesses.

[AllentownJake]

25. Even if the President thinks that himself

He can't get rid of him till after the mid-terms politically.

[Cant trust em]

26. Yup. I agree.

When people around here were talking about him being fired 6 months ago, I thought it was out of whack. I'd love for him to be gone in 2011.

[AllentownJake]

27. I hope he is there till 2012

Him resigning (getting fired) in 2010 or 2011 means something bad happened electorally in November.

[Cant trust em]

28. I suppose you're right. I remember jumping up and down when Rummy got the sack. nt

[emulatorloo]

6. Some very good points.

I trust Howard Dean when he says that this is a good bill that represents "real reform" - even if it is not perfect.

[bluestateguy]

8. DU is full of revisionist "pop" historians

Like all of the people lamenting that Obama is not another FDR.

Oh really? So you want Obama to order the internment of all Muslim-Americans?

[AllentownJake]

9. I'm sure President Obama

will commit his own sins that keyboard warrior historians can talk about in 60 years.

Don't worry, looks like he's planning one in Afghanistan right now.

[RepublicanElephant]

31. considering we live in the united corporate states of america...

this is our best shot for now, until the rest of america starts putting more progressives in washington.

[TomCADem]

36. Agreed, with Fox News running propaganda 24/7, it is hard to sustain support...

...over a year, let alone five years as was the case with Medicare. The insurance companies, of course, will fight back with their paid off politicians. I think we need to fight tooth and nail for the best reform we can get, then continue to fight for it. Legislation is not static, and it is a big mistake to think that anything stands still whether the subject is health care reform, financial regulation or climate change.

[Rosa Luxemburg]

32. We will get a single payer system eventually

just like in my old country England. My neighbor aske dme why I don't go back there!

[LiberalFighter]

34. We are better off where we are than starting all over.

We still have a chance to make the legislation better.

Even then, there will be opportunities to improve the legislation over the years.

I don't believe Medicare was as good as it is now.

[Rowdyboy]

38. I'm 55 and truly believe that its now or never if I'm going to see it happen....

Look how badly Bill Clinton was burned by health care reform.

[babylonsister]

45. I'm 53 and I agree. If we delay it will not happen anytime in the next

decade or longer. We cannot afford to wait.

[Oregone]

40. Its a tough call

Honestly, I don't see this bill as cost-controlling at all. Even if everyone is covered, it can still be burdensome individually and hurt America's national competitiveness. It may be very well worth scrapping it.

On the other side of the argument, an idealist AFL-CIO refused to support the Kennedy-Mills compromise bill (WAY, WAY better than this piece of shit), opting to aim for a perfect plan after the 1974 election further threw Congress in its favor, but it never materialized. In retrospect, Nixon's bill (which was what was being fought against) may of been every bit more progressive than this one.

At some point, you gotta cut your losses if you feel you have accomplished "enough". But this "enough" is a hell of a lot further behind what could of been passed in the past, had they "settled". There is never a guarantee you will be able to accomplish more later if you hold off. There is never a guarantee you will pass less. So its a very difficult decision to make.

I think that if you are not *sure* this will not only improve health care, but also social mobility (often not talked about), there is no reason to proceed. If it may help to some minor degree and open the way to further reform, it is worth considering.

I have no answer. I wouldn't personally so much as wipe my butt with it, but I'm not as desperate as the average emotionally involved American. Context is important though, and its interesting that you bring up the Medicare battle

[Oregone]

41. On second thought....they should beef it up, and force a fillibuster to kill it

That way they can control the message and scapegoat the Republicans for the country's perpetual problems. After the 2010 election, come back to the table with a bigger majority, the people completely in their corner, and a single-payer bill effective immediately.

[eridani]

42. Making the situation worse is hardly our best shot.

Medicare is now a done deal, so popular that even teabaggers on it don't want to have reform endanger their Medicare. Why not let the high risk pool in to start with? Then early retirees over 55 and unemployed people if doing it all at once is too scary.

[tomm2thumbs]

43. and per capita isn't getting everyone covered, so it is even more comparably

[johnaries]

44. I agree. I don't think we can wait 20-40 years for a "better bill". nt

[SpartanDem]

46. The wait for a better bill crowd might want to take a history lesson

We saw in the 1970's the Nixon pushed a health care plan that Ted Kennedy fought thinking Democrats would be back in power they could just implement a single payer system and Kennedy came to regret that decision. Of course, we remember Clintons plan going down in flames and there been to attempt until now to reform health care. History has shown that the I'd rather have nothing people will get exactly that, there will nothing better in 'just a few years' we will have to wait another decade or more

[Phoebe Loosinhouse]

47. I would love to scrap everything and start over but why would I think we would

get a different outcome? We would have the same guy at the top and all the same players in place except that we will most likely lose a few Dems (usual for the party in power in midterms) so exactly WHAT is going to change to improve this?

[brooklynite]

48. Better to pass what we can today...

Even if its not perfect, we've moved the baseline from "health Insurance is a matter for the private sector to decide" to "health care is a necessary public benefit, and the insurance companies providing services must do so in a competitive environment without picking and choosing their customers". Then start building from THAT point.

[backscatter712]

49. Understand that signing this bill into law is not the end, but the beginning.

This bill will help - more people will be covered, some of the most egregious gouging and scalping will be somewhat reined in, but we've still got a way to go.

Quite frankly, if we torpedo this bill because it doesn't go far enough, we will be shooting ourselves in the foot. Only it'll take thirty years before anyone in Congress even thinks about talking about health care again - they'll refuse after this mess if it all falls apart.

But if it's signed into law, in just a couple years, we can go back and say "We want more - modify the public option so it covers more people!" "Tighten the restrictions on insurers!"

Medicare and Social Security came into being the same way - lots of compromise, not everyone was covered by the initial implementation, then over time, they were expanded.

[impik]

50. No. We need to take this as a starting point

And getting it better with time. Whatever bill that comes out in the end, will be a huge improvement to the current situation. There's a reason no one could pass HCR in decades. That's how things goes in America, big changes comes in stages, nothing happens at once. But you gotta start somewhere. The insurance regulations alone are worth it.

[WeCanWorkItOut]

51. LBJ caved to special interests, caused a huge amount of unnecessary suffering.

He should have taken the time to do Medicare right.
But he let his ego get in the way. We can do better than that.

Rob Reich may want to knock heads and twist arms.
Let's not let such premature combativeness
get in the way of the rest of us thinking harder.

[still_one]

52. We wouldn't have Medicare today, if he didn't do what he did. Same with Civil Rights /nt