538.com: 20 Questions For Bill Killers

[malik flavors]

20 Questions for Bill Killers

by Nate Silver @ 1:30 PM

1. Over the medium term, how many other opportunities will exist to provide in excess of $100 billion per year in public subsidies to poor and sick people?

2. Would a bill that contained $50 billion in additional subsidies for people making less than 250% of poverty be acceptable?

3. Where is the evidence that the plan, as constructed, would substantially increase insurance industry profit margins, particularly when it is funded in part via a tax on insurers?

4. Why are some of the same people who are criticizing the bill's lack of cost control also criticizing the inclusion of the excise tax, which is one of the few cost control mechanisms to have survived the process?

5. Why are some of the same people who are criticizing the bill's lack of cost control also criticizing the inclusion of the individual mandate, which is key to controlling premiums in the individual market?

6. Would concerns about the political downside to the individual mandate in fact substantially be altered if a public plan were included among the choices? Might not the Republican talking point become: "forcing you to buy government-run insurance?"

7. Roughly how many people would in fact meet ALL of the following criteria: (i) in the individual insurance market, and not eligible for Medicaid or Medicare; (ii) consider the insurance to be a bad deal, even after substantial government subsidies; (iii) are not knowingly gaming the system by waiting to buy insurance until they become sick; (iv) are not exempt from the individual mandate penalty because of low income status or other exemptions carved out by the bill?

8. How many years is it likely to be before Democrats again have (i) at least as many non-Blue Dog seats in the Congress as they do now, and (ii) a President in the White House who would not veto an ambitious health care bill?

9. If the idea is to wait for a complete meltdown of the health care system, how likely is it that our country will respond to such a crisis in a rational fashion? How have we tended to respond to such crises in the past?

10. Where is the evidence that the public option is particularly important to base voters and/or swing voters (rather than activists), as compared with other aspects of health care reform?

11. Would base voters be less likely to turn out in 2010 if no health care plan is passed at all, rather than a reasonable plan without a public option?

12. What is the approximate likelihood that a plan passed through reconciliation would be better, on balance, from a policy perspective, than a bill passed through regular order but without a public option?

13. What is the likely extent of political fallout that might result from an attempt to use the reconciliation process?

14. How certain is it that a plan passed through reconciliation would in fact receive 51 votes (when some Democrats would might have objections to the use of the process)?

15. Are there any compromises or concessions not having to do with the provision of publicly-run health programs that could still be achieved through progressive pressure?

16. What are the chances that improvements can be made around the margins of the plan -- possibly including a public option -- between 2011 and the bill's implementation in 2014?

17. What are the potential upsides and downsides to using the 2010 midterms as a referendum on the public option, with the goal of achieving a 'mandate' for a public option that could be inserted via reconciliation?

18. Was the public option ever an attainable near-term political goal?

19. How many of the arguments that you might be making against the bill would you still be making if a public option were included (but in fact have little to do with the public option)?

20. How many of the arguments that you might be making against the bill are being made out of anger, frustration, or a desire to ring Joe Lieberman by his scruffy, no-good, backstabbing neck?

http://www.fivethirtyeight.com/2009/12/20-questions-for-bill-killers.html#comments

[Parker CA]

1. K&R Some good questions in there.

[FormerDittoHead]

57. Here are some good answers from Daily KOS...

http://www.dailykos.com/storyonly/2009/12/16/815402/-20-answers

3. Where is the evidence that the plan, as constructed, would substantially increase insurance industry profit margins, particularly when it is funded in part via a tax on insurers?

Where is the evidence that insurance companies would rig the system to extract record profits? I don't know. Perhaps the last decade or two might provide the answer.

=============================================

5. Why are some of the same people who are criticizing the bill's lack of cost control also criticizing the inclusion of the individual mandate, which is key to controlling premiums in the individual market?

Because without premium caps or a public-run competitive option, there is no incentive for them to lower their premiums. They have a monopoly, and monopolies aren't in the business of unilaterally reducing their prices. There are two ways to force them to do so -- government regulation or market competition. The former is out, and the latter is inadequate.

http://www.dailykos.com/storyonly/2009/12/16/815402/-20-answers

[Cant trust em]

2. Some really good points in there. nt

[Clio the Leo]

3. I await the answers...... NT

[harun]

8. Here's one: UNREC

[Clio the Leo]

12. lol so your answer to #20 is "yes"? NT

[grantcart]

38. see 37 below

[rockymountaindem]

4. What is his reasoning for the individual mandate being the "key" to controling individual premiums?

It would seem to me that without any public option competition of any kind, and with virtual monopolies by certain firms in some states, the mandate is the exact opposite of reigning in costs. It will just allow insurance companies to jack up rates on everybody (instead of just their existing customers) and rake in subsidies when people can't afford it.

As for his questions about the political ramifications, I would say passing a bad bill people will dislike is worse than doing nothing.

[itsrobert]

7. Don't throw cold water on their fantasy bill

You're right, without a hammer, these nails aren't going in and all you do is hurt your thumbs trying to push them in like tacks.

[rockymountaindem]

13. The whole thing breaks down when you consider there aren't any real cost controls

Having an excise tax to fund things is a fine idea that I support. However, let's say they tax 10 percent of 1000 dollars of profit. That's one thing. Then when the firms continue to increase prices over the years and we're still taxing 10 percent (forget trying to increase taxes later... that seems to be impossible) of 1500 dollars of profit, the insurance companies are still making more money than before. So where is the incentive to keep costs down?

With the public option, especially if the Wyden amendment had passed opening it to all, people would be able to get off a private plan if they felt they were getting ripped off and buy into something offered by the government. Now we've got nothing but a bunch of stilts for the existing private market to essentially function as before AND draw subsidies for doing so. Trying to just regulate and/or tax the private market is a shell game, because the ins. cos will find a way around it, lobby against any modifications like there's no tomorrow, and do their damndest (which seems to be pretty good) to ensure there are just enough loopholes for them to continue making scads of money and giving their customers sub-standard care.

[damonm]

18. Actually,

The insurers can't jack up rates willy-nilly - those rate increases must be justified and approved under the Senate bill.
Here's what the insurers get - I'd hardly call it a "win":

-required guaranteed issue of every insured with no underwriting requirements (buh-bye, "pre-
existing condition");
-requirement to submit rate increases in advance with full justification;
-requirement to post detailed information about how premium dollars are spent on the Internet;
-requirement to cover claims without lifetime or annual caps on benefits;
-requirement to adjust focus from illness to wellness by covering preventive procedures 100%;
-loss of the right to arbitrarily withdraw coverage from any insured at will right when the person
needs it most;
-limits on the differential between younger insureds and older ones.
In short, insurers get a hefty dose of regulation that they've resisted for decades - not what I'd call a "sellout".

I'd strongly prefer a robust public option, and I agree that it would be the most effective way to get costs down, but this bill just flat isn't as bad as many make it out to be.

[rockymountaindem]

19. Alright,

I thought the bit about no lifetime caps was removed in the Senate bill. That's been posted here multiple times and sounds like a huge problem. As for being required to submit rate increases in advance with full justification, I'd bet cash money that within a few years there will be complete regulatory capture of whatever bureaucrat is required to oversee that and it will turn into nothing but a rubber stamp. Plus, if the Congress ever becomes the slightest bit more pro-business than it is now, I wouldn't hold out much hope that they'll actually enforce that rule. That's why it would be best to write some stuff with actual numbers in it in stone now.

[napi21]

20. There are 2 reasons I know of that mandates would reduce costs.

#1 of course is the ability for everybody to go to the Dr. office when they were sick, and BEFORE they got VERY SICK!

#2 ER costs are the highest kind of HC you can get. With so many peoplenot being able to afford ins. most of them wait until they have no choice with their illness & just go to the ER where care MUST be providedwether the patient has the $$ or not. The costs for all those unpaid visits have to be covered by somebody! Even at non-profit hospitals, they have to cover those costs or they'd have to close their doors. They cover thoser costs by spreading them out over all the services they provide and ARE paid for, thus insurance costs are higher and all those who have ins. pay for those costs. That's the reason an asprin in a hospital is billed at $80-$100, or a box of tissues is billed at $15.00.

If most of the unnecessary ER visits wre eliminated, ALL costs would come down.

[backscatter712]

23. Here's a Thom Hartmann-inspired argument why mandates are less of a big deal than you might think.

Listening to his show, I remember him talking to a member of the Danish parliament, and he asked him "How can you deal with 55% income tax rates? Don't your constituents freak out because their taxes are so high?" And the answer was no, it wasn't. And that was because wages naturally adjust in response to tax rates. When you raise taxes, yes, it sucks for a little while. Then the effects ripple into the job market, job-seekers start demanding higher wages in response, and employers are forced to respond by paying higher wages, and after the job market reaches a new equilibrium, worker's take-home pay is about the same as it was before. The Reagan administration demonstrated the same thing. Taxes were cut, but then upward wage pressure diminished as a result, and a lot of workers had to eat pay cuts, or got smaller raises or no raises, and after the effects finished rippling through the economy, the worker's wages were probably the same as before, maybe even less.

It could be the same thing with the mandate - yes, it will suck at first for those who are uninsured, and are now forced to buy insurance. Then the job market will adjust to the new demands - workers will initially get that second job to pay that bill, but then workers will be more scarce, and they'll start demanding higher wages to pay for their now mandatory insurance premiums, and before long, employers will pay them.

Thoughts?

[On the Road]

26. Uninsured People Will Adjust to Paycheck Deductions

They will not adjust to requirements to pay out of pocket.

I live a working class area of South Baltimore. Most people have low-paying transient jobs. Many have prison records and work under the table or are unemployed. Many are thousands of dollars in arrears on child support. They can't even pay their rent or phone bill. It's crazy to think they can or will pay an insurance bill of several hundred dollars a month.

The enforcement mechanism, and the provisions for people who are supposed to have insurance but do not, are a huge issue. It will not end well short of a single payer system.

[backscatter712]

27. Basically, you're saying the bill won't help everyone.

And you're right. People will still fall through the cracks.

But the bill, including the mandates, will help a lot of people. A lot of people who didn't get insurance before will be getting insurance, and yes, this will have an effect on the supply/demand curve for wages that will help balance out the expense.

Don't forget that there's hundreds of billions of dollars of subsidies in the bill too, which will be applied on a sliding scale towards insurance premiums, and that will also help.

[On the Road]

28. That is True

It will help some people.

What I am more concerned about than a lot of people is the possibility it will actively hurt those whom it doesn't help.

[brentspeak]

46. "Getting insurance" means very little

You're under the impression that having insurance necessarily means having coverage. Even having "coverage" doesn't mean having health care. People pay thousands of dollars a month for a piece of paper that *may* provide some form of health care -- after they've already paid through the nose in deductibles and premiums. And that's the best-case scenario.

[brentspeak]

45. Bad comparison: In Denmark, 84% of health care spending is paid for by the state

Their high taxes http://yglesias.thinkprogress.org/archives/2009/10/health-care-in-denmark.php">directly yields high value.

As for the wage-adjustment theory -- unlike the United States, Denmark has a strong economy. They haven't given away their comparative advantage to China, India, and Mexico.

[Hello_Kitty]

50. "workers will initially get that second job to pay that bill,"

If people are having to get second jobs to pay for mandatory health insurance, there will be hell to pay at the polls in 2012. As for demanding higher wages, with what? The unions they've successfully busted the past 30 years? Shit, they'll just bring in immigrants or outsource.

Health care needs to be separated from your employment or your relationship and this bill doesn't do that.

[Hello_Kitty]

48. According to the most generous estimates the uninsured at 8% to the average premium

It's not insignificant hardly what I'd call "key" to bringing costs down. And don't assume the insurance cos. are going to pass those savings onto you anyway. Why would they if they know you're used to paying whatever you do now?

[Unvanguard]

29. It's adverse selection. Without the mandate, the pool of people with insurance

will be strongly slanted towards those with high risk, since insurance companies will not be able to discriminate.

[Hello_Kitty]

55. IMHO, adverse selection is mythical

We have no mandate now and the majority of Americans have insurance of sometime. Those who don't have it don't for reasons having to do with the cost and the lousy coverage of what is out there on the market. I used to work for a large company that provided excellent benefits. You had to pay a portion of your health insurance premium but it was reasonable and the coverage was fantastic. I saw a lot of young coworkers opt out of the 401k and stock plans, but I never saw a single one opt out of the health coverage. It's rather disappointing to see Nate Silver pushing the "free rider" meme of the uninsured on his post but getting support for an individual mandate requires you to "welfare queen" the uninsured.

[Scarsdale Vibe]

65. They have it now because insurance companies don't have to accept them

if they get injured or sick. After the bill is passed insurance companies will no longer be able to deny people based on pre-existing conditions so the incentive to have health insurance decreases significantly. If your company assured its employees that they would still be able to access the health insurance plan AFTER they got sick even if they hadn't initially signed up for it, then anyone who chose to opt-in to the health insurance was a moron.

[Larkspur]

5. Remove the mandate to buy insurance

This bill will make us slaves to the health insurance companies.

[Cha]

6. Can some people read these

through their rage?

Thanks Nate Silver for bringing these questions to light..maybe we'll get some answers.

[Phx_Dem]

9. Doesn't Nate know the "bill killers" only care about themselves.

Who cares if poor people get subsidies so they and children can finally have access to health care. Please. Like anyone is supposed to care about that!

If "I" don't get to have a government-run plan, "they" don't deserve anything coverage at all. That makes sense, doesn't it?

[rockymountaindem]

16. That only makes sense if there's some incentive to keep costs low

Instead there is the exact opposite.

I would be fine with subsidies to private insurance companies if there was some kind of explicit, rigid cap on what they could charge. The bill could say that prices for care could only increase at a certain rate, perhaps pegged to inflation in some way. There could be some kind of consumer protection commission, maybe, that would be able to enforce pricing. When people say that this is supposed to look something like the Swiss system, they are ignoring the fact that the Swiss system has low profit margins (not the 85% that this bill would allow insurance companies to keep) and lots of really strict legislation about prices that this bill lacks.

If the poor receive subsidies to pay for health care based on costs today, that is something I'd be fine with. But what about five years from now when costs have continued to rise? We'll have two options: make the poor pay the difference out of pocket, or increase subsidies. We can't do the former because it would make the poor go completely broke (thanks to the mandate and lack of any public plan to turn to other than Medicaid, which they would already be on if they were that poor). That leaves subsidy increases as the only real option in this case. That means, as far as I can tell, that the insurance companies will just keep saying "oh, costs are going up" like it's something completely out of their control, and then say they need more subsidies if they are going to suppress out-of-pocket costs. That sounds like a license to print money. Drive up costs yourself, and then tell the government the only options are to bankrupt the poor or hand over more taxpayer money.

It's not as simple as your moralistic plea would indicate. This bill might work fine *right now*. In the future it won't be sustainable.

[Lilith Velkor]

25. I doubt the poster you are replying to has ever even met a (working) poor person.

If s/he had, s/he would know that most of us pay out of pocket now, because we can't afford to pay for insurance that might or might not pay medical bills when we're struggling to make rent.

You're better off paying protection money to the Mafia, because they keep their word. Insurance companies, not so much.

[grantcart]

40. This bill would work for my family

We haven't seen a doctor for 10 years

I probably have diabetes.

But I am against this bill.

It is not an expansion of government care, it is a forced wedding that will leave private insurers in charge.

[depakid]

54. Some of have worked hard in public health- often for little recompense

on all sorts of issues that don't benefit them directly. Could be we see a much bigger picture on the matter than you do (which may well come from having both been in the trenches and earned advanced degrees in the field).

[cry baby]

10. thought-provoking questions, indeed! knr

[jenmito]

11. K&R. Nate Silver knows what he's talking about. n/t

[OHdem10]

14. 30 Million new guranteed customers should add a little profit????

Re fiddling around the margins. If there is a Republican Rout
in 2010 or if we get more Republicans and lose Democrats---
down goes any chance of " fixing it". This makes it imperative
that it get done right at the present time.

Actually, it is very straightforward. Mandating people to
buy Insurance from the Insurance Companies is one big fat
gift. You can bet the Champagne and Wine glasses are clinkin
in every Insurance Co in America. The Public Option was
an opportunity to provide competition and give people with
minimal resources a place to go. Do not say--Subsidy.
There are hundreds of Thousands who will be pressed. Those
who will be one dollar above the income required to be
eligible for a subsidy. Besides only a few people a year
can even be covered. Those who have to wait will be resentful.

The Smart thing would have been to have focused on either
covering and getting uninsured covered and put Medicare
reform off until later. Or done Medicare Reform now and
the Uninsured later. This bill has become a mish mash
because they were so busy trying to make things fit. Taking
away from Peter to pay Paul. Many live in fear of what they
have done to Medicare.

[AlecBGreen]

15. OK ill bite

1. Over the medium term, how many other opportunities will exist to provide in excess of $100 billion per year in public subsidies to poor and sick people?

Giving my tax money to an insurance company just so they can **** over another poor American is not my idea of good politics



2. Would a bill that contained $50 billion in additional subsidies for people making less than 250% of poverty be acceptable?

What are you talking about?



3. Where is the evidence that the plan, as constructed, would substantially increase insurance industry profit margins, particularly when it is funded in part via a tax on insurers?

Mandate people MUST buy insurance. GIVE money to the insurance companies to cover the people who cant afford it. Allow recissions as normal, allow yearly limits. Yeah, thats a recipe for slashing corporate profit </sarcasm>



4. Why are some of the same people who are criticizing the bill's lack of cost control also criticizing the inclusion of the excise tax, which is one of the few cost control mechanisms to have survived the process?

Because many people, including teachers and union members, gave up pay raises in return for good insurance. Now those "cadillac plans" will be taxed? Gee thanks.



5. Why are some of the same people who are criticizing the bill's lack of cost control also criticizing the inclusion of the individual mandate, which is key to controlling premiums in the individual market?

LOL. OK, you FORCE someone to buy junk insurance then fine them if they dont? What a wonderful f*ing idea.


6. Would concerns about the political downside to the individual mandate in fact substantially be altered if a public plan were included among the choices? Might not the Republican talking point become: "forcing you to buy government-run insurance?"

Dont get me started on Republican talking points. If we had half the guts the GOP does we would smash their bullsh*t talking points back in their fat pasty faces. And Yes, it WOULD be substantially altered. "You must get covered but you can buy into medicare."


Im at work and dont have the time to get thru all these. Nate Silver is a smart dude but this list is BS.

[rudy23]

17. I've found that Nate Silver lacks the ability to think qualitatively at times.

He's a numbers geek who thinks you can solve things on paper given that people behave rationally.

[Cant trust em]

22. Good point, but I'd also say the opposite about many liberals.

I find myself falling into that trap sometimes.

[rudy23]

24. I agree. Me, too. nt

[Unvanguard]

30. Do you have a specific response to his argument? n/t

[backscatter712]

21. Reccing this one.

Yeah, I know - everyone's gonna be calling Nate Silver a "TRAITOROUS SELLOUT!!!!111!11one", but he's probably one of the most level-headed liberal voices out there, so go ahead and disagree with him, but I think he's worth reading.

[Milo_Bloom]

31. Extremely unconvincing

"1. Over the medium term, how many other opportunities will exist to provide in excess of $100 billion per year in public subsidies to poor and sick people?"

As many as congress wishes.

"2. Would a bill that contained $50 billion in additional subsidies for people making less than 250% of poverty be acceptable?"

In and of itself, yes, so long as it is not tied to a mandate for all to purchase insurance.

"3. Where is the evidence that the plan, as constructed, would substantially increase insurance industry profit margins, particularly when it is funded in part via a tax on insurers?
"

No Cost controls, mandated insurance, tax is easily passed onto the consumer. More people buying insurance = greater profit margins.

"4. Why are some of the same people who are criticizing the bill's lack of cost control also criticizing the inclusion of the excise tax, which is one of the few cost control mechanisms to have survived the process?"

Because it doesn't actually control costs.

"5. Why are some of the same people who are criticizing the bill's lack of cost control also criticizing the inclusion of the individual mandate, which is key to controlling premiums in the individual market?"

See #4.


"6. Would concerns about the political downside to the individual mandate in fact substantially be altered if a public plan were included among the choices? Might not the Republican talking point become: "forcing you to buy government-run insurance?""

No because you wouldn't be forced to buy government-run insurance. The government option would be the cheapest available and could actually be fairly easily implimented via a tax to those who choose to buy no insurance at all.


"7. Roughly how many people would in fact meet ALL of the following criteria: (i) in the individual insurance market, and not eligible for Medicaid or Medicare; (ii) consider the insurance to be a bad deal, even after substantial government subsidies; (iii) are not knowingly gaming the system by waiting to buy insurance until they become sick; (iv) are not exempt from the individual mandate penalty because of low income status or other exemptions carved out by the bill? "

Makes the false presumption that the subsidies make insurance affordable. It doesn't.


"8. How many years is it likely to be before Democrats again have (i) at least as many non-Blue Dog seats in the Congress as they do now, and (ii) a President in the White House who would not veto an ambitious health care bill?"

1.5 if they played their cards right.

"9. If the idea is to wait for a complete meltdown of the health care system, how likely is it that our country will respond to such a crisis in a rational fashion? How have we tended to respond to such crises in the past? "

No differently than we are responding now. Making all the same mistakes over and over again. e.g. see the bank meltdown of 2008.


"10. Where is the evidence that the public option is particularly important to base voters and/or swing voters (rather than activists), as compared with other aspects of health care reform?
"

Check the polls. In fact, the lastest poll shows support for this bill dropping SHARPLY after the public option is taken away.

"11. Would base voters be less likely to turn out in 2010 if no health care plan is passed at all, rather than a reasonable plan without a public option?"

They would be MORE LIKELY to turn out if given a specific task. "We need you to pass health care reform". If you make the election ABOUT health care reform, they will turn out.


"12. What is the approximate likelihood that a plan passed through reconciliation would be better, on balance, from a policy perspective, than a bill passed through regular order but without a public option?"

100%

"13. What is the likely extent of political fallout that might result from an attempt to use the reconciliation process?"

0

"14. How certain is it that a plan passed through reconciliation would in fact receive 51 votes (when some Democrats would might have objections to the use of the process)?"

Likely

"15. Are there any compromises or concessions not having to do with the provision of publicly-run health programs that could still be achieved through progressive pressure?
"

No

"16. What are the chances that improvements can be made around the margins of the plan -- possibly including a public option -- between 2011 and the bill's implementation in 2014?"

Absolutely 0.


"17. What are the potential upsides and downsides to using the 2010 midterms as a referendum on the public option, with the goal of achieving a 'mandate' for a public option that could be inserted via reconciliation? "

Upside, getting a bill that isn't a massive gift to the insurance industry with REAL reforms and controls. Downside, finding out that the public really doesn't care about health care reform and we can pass the same garbage bill we have now.

"18. Was the public option ever an attainable near-term political goal? "

Of course.

"19. How many of the arguments that you might be making against the bill would you still be making if a public option were included (but in fact have little to do with the public option)?"

If it was a strong public option (essentially a medicare buy in for all).. none, as it would be the ultimate cost control.

"20. How many of the arguments that you might be making against the bill are being made out of anger, frustration, or a desire to ring Joe Lieberman by his scruffy, no-good, backstabbing neck?"

None. The bill does more harm than good and needs to be killed because it is actually destructive.

[malik flavors]

33. Your answers were extremely unconvincing

[Milo_Bloom]

34. They are, however, correct.

[freddie mertz]

39. Excellent answers. Nate is not a very convincing political pundit.

He's good with voting numbers.

Too bad he can;t see the forest for the trees in this crazy bill.

[itsrobert]

59. Good answers. But the Obamabots are not listening

They are like Michelle Bachman with their fingers in their ears.

[FormerDittoHead]

62. +1 n/t

[ncteechur]

32. absolutely!

[RoyGBiv]

35. Excellent questions ...

Thank you for posting

[grantcart]

41. Really? I didin't think that they were on point at all.

[RoyGBiv]

44. I did

Most of them anyway.

[grantcart]

47. What are the 2 questions that you thought were most relevent to the discussion?

[RoyGBiv]

49. Define "the discussion"

To which specific discussion do you refer?

With regard to the idea of killing the Senate bill, along the lines of what Dr. Dean has proposed, I find questions #12 and #14 particularly important, but I think the whole question that surrounds "kill the bill" is premised on #18.

[grantcart]

51. Those are the questions that I considered the most irrelevent

Its like asking what are the chances of succeeding at Normady before the battle.

We don't know the personalities involved and have no access to any study that would give us a basis to guess on.

Obviously the tactic that the President, Pelosi, and Reid thought would work has failed.

Another strategy might also fail but that is unknown.

It is something akin to people arguing against the use of MJ when the known damage of alcohol is significantly greater than the worst projections of MJ.

The question he didn't ask is "What will the collateral damage to the party be when it significantly expands government function (and as he wants to point out 'subsidies for low income folks' and then hands the actual administration of those dollars to private companies that have demonstrated an almost insatiable appetite for greed".

This becomes an even more important question when everyone's plans continues to increase because he seems to concede that the bill " bill's lack of cost control".

[RoyGBiv]

56. Strategy ...

I think your battlefield analogy fails on a fundamental level, but for the sake of argument let's run with it.

Would it be your contention that the planners of the Normandy invasion did not ask themselves and discuss with each other the chances of success? If so, what motivated them to choose Normandy? Why did they not choose Calais? Indeed, if the chance of success was never asked and no answer attempted, why did they not just stick a pin in a map of mainland Europe near a body of water? If no one asked about the chances of success, why didn't they just pack up and go immediately? Why wait, plan, and prepare for two years?

If you will concede the reality, which is that the Normandy invasion encompassed a great deal of planning during which several scenarios were considered, most of them eventually concluding that an invasion on the Normandy coast offered the most likely avenue of success, would you then also concede that asking whether an attempt at something as politically difficult as passing legislation incorporating a public option might succeed in Congress may have occurred? If so, what was the answer?

Continuing with the Normandy analogy and incorporating a bit more of your comments, might it have been the case that Obama, Pelosi, Reid, et al did ask this question and came to individual conclusions that the type of public option that was included in the main bills did have a chance of success in the House and Senate respectively, but that it was no sure thing? And might they have considered this in the context of a broader strategic plan, i.e. the possibility that it would fail now but that something else might prove more important over the course of time?

Here we are forced to deviate from Normandy because, in the eyes of the Big Three during WWII, the successful invasion of Normandy was an essential element to success in the war overall. However, our big three in Congress and the White House do not seem to have believed a public option was immediately essential to success of the basic effort. One may disagree with whether the strategy is a sound or correct one, but I think to deny that this was a part of the strategy -- the elevation of certain goals over a public option in importance -- is denying what increasingly seems to be the reality.

The problem *we* have with this is that many of *us* saw things the other way around, to wit that the public option (or earlier so-called "single payer") was the prime goal. I recall very few statements from a very few individuals that even suggested this, much less stated it outright. Certainly all of the big three declared it in one way or another as "a" goal, but not "the" goal. This is not offered to excuse them from not having made it a primary goal in accordance with many of our wishes, but it does in fact bring into the spotlight the question of whether the public option was ever an achievable goal, to what degree it has been considered achievable, and how it may have been used by our leaders in achieving a different goal than what we wanted (or thought we wanted) them to pursue.

And so I think it is an important question.

[Sunnyshine]

36. Here:

http://emptywheel.firedoglake.com/2009/12/15/health-care-on-the-road-to-neo-feudalism/

20% of your labor belongs to Aetna

It’s one thing to require a citizen to pay taxes–to pay into the commons. It’s another thing to require taxpayers to pay a private corporation, and to have up to 25% of that go to paying for luxuries like private jets and gyms for the company CEOs.

It’s the same kind of deal peasants made under feudalism: some proportion of their labor in exchange for protection (in this case, from bankruptcy from health problems, though the bill doesn’t actually require the private corporations to deliver that much protection).In this case, the federal government becomes an appendage to do collections for the corporations.

It’s the 9.8% tithe that bothers me the most. But for those who think we can fix it, consider this, too. If the Senate bill passes, in its current form, it will mean that the health care industry was able to dictate–through their Senators Joe Lieberman and Ben Nelson–what they wanted the US Congress to do. They will have succeeded in dictating the precise terms of legislation.

Most of that article refutes and diminishes this game of 20 questions.

I can think of my own list of 20 questions to ask HCR supporters and our Legislators. Here is a quick 5:

1. What happened to holding open HCR hearings in the public where Single Payer and AHIP have equal chances to make their case.

2. Why does the current proposal look nothing like this: http://www.barackobama.com/issues/healthcare/

3. Why are they protecting corporations that make 30% profit- when we know public plans make only 4%?

4. Would it have made a difference if our President and Dem. leaders held town hall meetings to clearly define National Exchange.

5. Where is the list of 20 ways Democratic Leaders advocated and pressured detractors in support of the majority who want PO.

/words

[freddie mertz]

42. Thanks for that link.

Remember this one?

"Offers a public health insurance option to provide the uninsured and those who can’t find affordable coverage with a real choice."

That is what Obama called "the sliver."

Funny how he never really fought for it after that.

[Sunnyshine]

52. And I mean really fought for it like they fought to become elected.

Instead, it is a jumbled up mess of a bill that shades the already blurry margins and dumps key elements which the public supported.

The PO should not be negotiated via and along side private insurance reforms. If they wanted to do this right, those reforms should have been handled separately and negotiated apart from a clearly defined bill that contained the logistics of a real PO.

Now that would be providing competition and also allow for honest assessments of each proposal.

We failed to tap into the dynamics of the markets working together to enhance health care and control costs for consumers.

[itsrobert]

Excellent response. Obama thinks we are suckers

I expect no one to answer your questions.

[grantcart]

37. Answers

1) $ 100 billion in subsidies. These are subsidies to the companies not low income people. With no public option there is no competition and no cost control.

2) No see above

3) Basic economics. Even if the gross profit measure declines the huge increase in the total pie will expand significantly creating additional net actual dollars.

But there is an even more base point. Some Republicans have made the point that the health industry does not have a very high profit percent. This shows that the CEOs cheat not only their clients but their shareholders.

Where in the legislation does it lay out that corporate bonuses will be he controlled?

4) The key justification for the bill was cost control. That no longer exists. That should kill the discussion and the questions.

5) People who criticize the individual mandate do not understand the principle of "Regulatory Selection" and are well meaning but wrong.

6) The concerns would be altered because people would compare the plans and make a free choice.

7) The question is irrelevent because without cost controls all of the options will get worse.

8) We can expand medicare now with reconciliation

9) Stupid question.

10) The evidence is that it provides competition. When people sign up for it and leave their private plans you will have concrete numbers. In the meantime the extreme measures that the HC industry is going to fight it proves the point.

11) Really irrelevent. Think over the next 15 years when the people identify Democrats with an expanded workable plan and the Republicans being against anything. How damaging will it be when this administration becomes wedded to every decision by every health insurance company over the next 8 years?

12) An expanded medicare plan would be relatively simple to pass through reconciliation.

13) None - its been used before. Again what is the fall out of being tied to a disaster see 11)

14) Getting silly now.

15) NO

16) None

17) That would be a plan if we didn't pass this bill. If we pass this bill then we will spend 100% of the time on the defensive.

18) Of course it was.

19) 8.3

20) None this business nothing personal.

[TheKentuckian]

43. Good questions but you also have to ask at what point have you sold the farm

I find it pretty difficult to make that call but the reek increases as the seconds pass. There is a real potential to long term do more harm than good here and too many elephants in the room cannot be tolerated. There have to be some kind of active price controls or this turns into a controlled re-entry rather than a flat out crash. I don't have coverage myself but I'm not into scuttling the entire country by just bailing some of the water while the hole gets wider by the day.

Something has to be in place to literally limit the amount of dollars that passes through the hands of big insurance or there will be nothing to stop them from doing exactly what their model is now which is to have as many dollars as possible stream through knowing that a certain amount is acceptable profit. At the point the idea is to increase the volume and we are in deep if we allow that to happen with the additional danger of guaranteed state funding or at least the customer mandate should that fall apart. Hell, don't they get the fine money too?

One day it could be 300 million times whatever the penalty is as a free life support to a vampire industry. I'm not saying it is like that but we better tread carefully because the potential for epic screwing is decently strong here.
We can't keep letting them sell whatever cost containment there may be as price control.
We can't allow the mandates without some surety of affordability and not just of premiums and we can't be satisfied with letting people into a system that they are still largely unable to utilize because they still won't be able to afford their individual contributions. If you have to pay X% of your income before they pay a dime then folks that can't afford to pay attention still go uncared for or wait too long and jack the cost of getting better up higher.

I think we all have to accept that better than now and where now projects out to may have to be acceptable while remembering that the path to Hell is paved with good intentions, this can't be a cover as many as possible and damn the torpedoes proposition.

There has to be win, not just not losing at some point, as a mentality. I promise that there is a point of jumping off a cliff to avoid a broken leg that we must yet navigate successfully away from here.

There also has to be some real mechanisms to enforce the regulations and direct recourse for the individuals when they are violated or circumvented or they are pointless.

It's not enough to say "This bill saves lives" because it has to also cause enough less to be a net positive. We have to address affordability and enforcement or no plan can possibly work other than as a means to funnel money to certain corporate quarters. Nate, Obama, and Congress need to be talking about what this will look like on the ground for people all through the income spectrum (especially at the lower end where 90% of us hang out) or all of those good questions won't matter because the plan won't work and we'll take the fucking heat for something that like 95% of the party didn't even want but were hijacked by a handful of assholes and forced into stupid shit or the nearly equally stupid doing nothing despite knowing how jacked up nothing is.

Making things generally worse to cover more people isn't an acceptable "compromise". When you're spending about 800 billion (plus inflation and possibly interest) every six years you can't afford to not at least make the general situation observably a little better or at worst the same but everyone has access. You can't spend that much and things feel more sucky and folks still can't really get treatment they can afford.

[depakid]

53. Reading 538 lately, it looks like Nate is bucking for a position with the administration

And one thing for sure, he's eminently qualified.

[uponit7771]

58. The fact haters will ignore the questions

[itsrobert]

60. See post #21

Easily answered. The bill is a failure as is.

[Phoebe Loosinhouse]

61. Here is Kos' answer to Nate

http://dailykos.com/

2nd featured Diary on the lefthand side.

[mcablue]

64. Progressive website Firedoglake has also answered the questions (link)

http://fdlaction.firedoglake.com/2009/12/16/answering-nate-silvers-20-questions-on-killing-the-senate-bill/

[Garam_Masala]

63. 11 Answers to your questions------------->

1. No Single Payer

2. No public option

3. No expanded Medicare coverage

4. No drug re-importation

5. No cost controls

6. No renegotiation of drug prices

7. Capped annual coverage for care

8. Individual mandated coverage

9. Anti-trust exemption for insurance companies

10. A tax on middle class insurance plans

11. Taxes that start up in January, but benefits that don’t start until 2014