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The "break the bill in two" concept

Single payer advocates argue that the only way forward with health care is to pull out the good parts that help people right away, declare victory, and reboot with an open and transparent process -- this time, for real. Naturally, the "progressive" access bloggers never refute these arguments directly, since that would give oxygen those who advocate the only policy on offer that can be shown to save money and lives, but apparently they've been talking privately among themselves about it. Here's the implicit "progressive" response and strategery (via Ackroyd at Eschaton):

The problem is, you give up on this and what do Democrats have to exclaim about doing for healthcare reform in 2010?

Who gives a shit?

Individual mandates? Making people buy crappy insurance from the same old insurers that will continue to find ways to exclude their claims and jack up their premiums?

Which none of the bills change.

Giveaways to the insurance industry of upwards of $600 billion in the form of the subsidies and credits given to the people who are forced to buy the crappy insurance?

Which none of the bills change.

The problem is, as Greg Sargent points out, is that Lincoln, Landrieu, Nelson, and Lieberman share a characteristic of the Republicans: they just don't really give a shit that people are suffering.

Bollocks. That's not the problem at all.

If Democrats, and "progressive" access bloggers, gave two shits about caring whether people suffer -- as opposed to congratulating themselves and their clients on being seen as caring -- they would never have pulled the bait and switch on [a|the] [strong|robust]? public [health insurance]? [option|plan] in the first place, or stood by as it got whittled down from 130 million enrollees to 9 or 10 or 6 million or 2 percent of the population or whatever. They've never been straight with the American people on how many enrollees there would be, they've never been straight on shit like "Day One" being in 20134, they've never been straight on how the exchanges would actually work, and on and on and on.

They have no problem "letting the whole thing come crashing down, with potentially catastrophic consequences for their party and, by their own lights, the country as a whole."

Translation: They know how to bargain. Either (#1) "progressives" don't, or (#2) they don't really care. Since I don't accept Democratic narratives of weakness, I'm going with door #2.

And the remainder of the Senate, and the vast majority of House members who do care are hanging on to the shreds of a hope that they can make this whole mess just a little bit better, even if just for a sliver of the population.

Translation: "Just a sliver" means that to this very day, public option advocates don't know -- or won't say -- what they're advocating for, or what their bottom line is -- except, possibly the semantics or optics of getting the word "public" in the bill.

The alternative, of course, is for progressives to be just as willing as the ConservaDems to blow this thing up. Sherrod Brown says he's still committed to the public option, and that it will be difficult to maintain the support of progressive Senators if this gets watered down any further.

"Difficult." Now that's telling 'em, "progressives!"

The most obvious solution is to break the bill up into two, pass the insurance reforms through regular procedure and the public option and other financial pieces through reconciliation.

Translation: Pass the parts that everybody agrees on, then shove the shit sausage down our throats with reconciliation.

And all for "a sliver"? Are you shitting me?

It's the Rube Goldberg health exchange contraption, and saving no money, and forcing us to buy junk insurance, and the IRS acting as a collection agent, and making us pay up front for benefits that don't kick in 'til after the next midterms when 45,000 are dying every year, and using the tax system to claw back plans that unions won through bargaining, and turning the right to universal health care into a fucking welfare program with Medicaid expansion, and legitimizing health care for profit --- those are the problems! And that's what you're going to pass with reconcilation? It's a sure-fire political winner!

That's our excrementalist "progressive" caucus in action. Sucky on policy, sucky on politics, and setting themselves up for a loss in 2010 and 2012. Not that it matters to them anyhow: They're made in Versailles anyhow...

NOTE More of the same, except with over-the-top framing.

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madamab's picture
Submitted by madamab on

Understand that the current so-called "public option" is tied to Medicaid. Which is tied to the states and state taxes. Which means that all the problems with the states being in huge deficits because of the Bush tax cuts (and having to balance their budgets regardless) will carry over into the "public option." Which means it will be funded as little as possible and most doctors won't even take the patients because they know there will be a hell of a time trying to collect from the State. As an extra bonus, state taxes will most likely go up for the next 4 years to pay for it, as well as federal taxes. Awesome!

There is no hope of this doing any good whatsoever for anyone. And what about the women who will be actively harmed by this bill? I'll bet Ackroyd doesn't see fit to mention that either.

S Brennan's picture
Submitted by S Brennan on

I've given up on talking to my Reps because they're voting for this shit sausage come hell or high water.

My response is to vote for the candidate most likely to unseat them. Yes in all likelihood that means getting somebody worse...but Democrats, since 2000 have worked so hard to close the gap between themselves and the right wing extreme that as Harry Truman said, "give the people a choice between two Republicans..and they'll vote Republican every time"

Top to bottom, this is the worst set of Democrats ever, they [and their supporters] have to be removed before we can go forward.

beowulf's picture
Submitted by beowulf on

Right and it begs the question, why even bother reforming insurance? If people are happy with the private insurance they have now, more power to them. There's no need to reform rescission or pre-existing condition rules if Medicare is expanded to cover everyone. A straightforward Medicare expansion could be done with 51 senate votes via Reconciliation.

In a perfect world, 1. the Senate bill dies, 2. Charlie Rangel gets indicted, 3. Pete Stark moves up to Ways & Means Chair and pushes his "public option on steroids" Americare bill. The Commonwealth Fund estimated 85% of the population would end up in the public plan, with a solid 1% remaining with private insurance (the remaining 14% would stay with existing government programs).
http://www.dailykos.com/story/2009/6/7/7...
http://pnhp.org/blog/2009/01/09/commonwe...

Since the Americare bill expands an existing program (Medicare) and doesn't bother with Obamacare's ineffectual insurance regulations, it could sail through the Reconciliation process without being chopped up. The program would start Jan 1, 2011. Politically, its strongest point is that it doesn't require a tax increase. The achilles heel of HR 676 has always been the tax hike, Weiner's version called for increasing the payroll tax rate by 14 points. Heck, even the dog food on the table has tax hikes-- which would start immediately even though the program itself wouldn't start till 2014. I can't possibly imagine the GOP winning elections on THAT issue.

Submitted by hipparchia on

or cut funding from somewhere else, it raises the federal government's expenditure on health care, even though it lowers the national spending overall.

you wouldn't have to raise taxes very much, because under-65s would pay for their use of medicare with premiums [presumably the full premium if they make enough money] instead of with taxes. weiner's plan [and the original hr 676] would pay for it all with taxes.

beowulf's picture
Submitted by beowulf on

There are $800 billion in premiums paid in for employer-provided health insurance, Stark's bill redirects this into the Americare trust fund. The employer mandate requires paying for Americare coverage or a private equivalent, but the Commonwealth Fund report makes it plain that the federal plan would underprice any private competitor.

Stark's bill moves Medicaid and SCHIP clients and funding into the Americare risk pool (kids are typically in great health, so they bring down the average cost of care) and mandates that the states pay into the Americare trust fund what they'd otherwise have spent in Medicaid funding, which I believe is now over $150 billion a year.

Submitted by hipparchia on

[i'm not going to try to bring it up on this computer, too slow] says that stark's bill increases overall federal spending by something like $180 billion in 2010 and that appears to be after taking into account all the things you mention.

beowulf's picture
Submitted by beowulf on

Skimming through the bill, I don't see any other source of new federal revenue beyond redirected premiums and state Medicaid funding. Presumably Stark made the bill revenue neutral, but I don't think the CBO has scored this one either (speaking of which, I never came across the CBO report for Weiner, maybe Sanders can shake it loose). If there is a $180 billion revenue hole, I'm fully in the Dick Cheney camp ("deficits don't matter"), but the simplest fix is uncapping the Social Security part of FICA for incomes over $106,000. This would bring in over $200 billion without increasing tax rates. Having said that, I'd be surprised if Stark's staff (he chairs the W&M Health subcommittee) hadn't designed the bill to be revenue neutral, if only on paper.

I do agree with you that a single payer regime is economically and equitably superior (heck, I'd support VA Healthcare for All), I just think that the Stark bill's compromises make it a easier to garner support for than HR 676 and yet still moves us strongly in the right direction, its 85% public option to 1% private option ratio is almost exactly reverse of what the current Senate bill has in store.

Submitted by hipparchia on

has to go to social security, and the medicare tax has to go to medicare. they're both fica taxes, but each is earmarked for its particular trust fund.

i don't mind keeping stark's bill as a backup compromise position, but at the very minimum we need to start off with going for hr676, or better yet, how about hr3000?

beowulf's picture
Submitted by beowulf on

But apparently Pelosi may bypass him for a less senior member (like John Dingell was bounced for Henry Waxman at Energy & Commerce).

The LA Times ran an article last month about Stark and his possible Ways & Means chairmanship.
Rep. Pete Stark: ambition vs. a big mouth
One of Congress' most impolitic politicians is next in line for a plum leadership role. Stay tuned.
http://www.latimes.com/news/nationworld/...

gqmartinez's picture
Submitted by gqmartinez on

I think that's a good analytical framework. The progger Pibbers are actively baitin' N switchin'. They are actively harming us. Nothing passive about it.

beowulf's picture
Submitted by beowulf on

If you're not interested in what Lambert (or anyone else here) has to say, why bother reading, registering an account and then commenting at his website? Surely there are better ways to occupy your beautiful mind, I think Perez Hilton has a new Lindsay Lohan thread up.
http://perezhilton.com/

Submitted by lambert on

I welcome your wanking.

One thing that has to be done is cover the single payer news, and opinion, since the access bloggers censor it. Which we do. That's why I don't grant your suicide requests, mithras; when you start frothing, I know that heat has been applied in the right place.