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An overly-long rant about HCR

by Izzy Mon Jan 25th, 2010 at 05:34:01 AM EST

"Death to insurance!  Raze their buildings, burn their actuarial tables, and salt their office complexes.  The insurance industry must die."

That was me writing in 2004.  I feel a bit funny quoting myself, but I just wanted to make sure we're all very, very clear on my feelings about the insurance industry -- I hate it.  

I'm also quite hard line on my political stance that PROFIT and MARKETS have NO PLACE in the healthcare debate.   Anyone who looks at people's misfortune and misery -- their injury and illness -- and seeks to make a profit from it should be reviled and shunned by decent people everywhere.

Ok, so now that we have my feelings and beliefs on the matter firmly established, follow me over the jump if you want to hear why I whole-heartedly support the passage of the US Senate Healthcare Reform bill.


In the interest of full-disclosure, let me tell you a few pertinent facts about myself.  I'm currently uninsured, so this debate directly affects me.  Not only am I currently uninsured, but I was raised poor and spent much of my childhood without health insurance.  

Further, I was in a serious car accident as a teen, which has left me with various health issues.  I've spent much of my adult life dealing with illnesses and problems which have often resulted in having to have some sort of surgical intervention.  I've also been incapable of sustaining full-time employment which, here in the US, means I've never had health-insurance except through either husbands or the state.  

I am, for all intents and purposes, uninsurable under our current system.

Given all this, I've been fairly lucky.  My grandmother who raised me was British, so as a child I had dental work done in Scotland.  When I came down with TB, it was treated by the public health department.  After my accident, my multiple traumatic injuries were life-threatening, so I was promptly treated at LA county hospital.  

When I regained consciousness a week later and was being kicked out, I'd been fortunate enough to have been in the car with a movie star's kid driving -- his insurance forked out the dough to both pay county and give a cash advance to the other hospital, who wouldn't admit me otherwise.

When I was having complications a few years later, and had been hemorrhaging for a month, I just happened to be dating a guy in the military.  They have good benefits.  I hastily divorced my first husband and spent the day after my second marriage in surgery.  

During that marriage, I had my son, got my teeth fixed, and had several more surgeries.  I ended up disliking my second husband quite bitterly, but on paper, we were married for YEARS after the rot set in -- far into my relationship with what would be my third husband, only getting divorced from #2 when he wanted to remarry.

My third husband, who's now out of the picture, uprooted his business and moved with me out of California to Washington state, motivated in large part by the fact that Washington had state-based insurance.  My son stayed insured through his father.  My insurance kicked in in Washington just in time for me to have my last major surgery which saved my life.  

Unfortunately, it wasn't in time to save a large chunk of my bowel, which I'd probably still have had I had consistent treatment and had the surgery earlier.

In the meantime, my parents were getting older and having their own health problems.  They moved up to Washington with us and I became, to some extent, their advocate.  You might remember my having written about just one of their issues.  During those years in Washington, I also dealt with my grandmother's final illness and my Uncle's suicide after years of battling mental illness.  I took care of all their bills, paperwork, and arrangements.

I tell you all these personal details for a reason:  I've dealt with my grandmother's very good private insurance.  I've dealt with the government's medicaid and medicare plans,   I've dealt with crappy HMO's.  I've dealt with the military's Tri-care basic and their other plans, as well as used their clinics and been in their hospitals.  And I've been insured through 3 different plans from private insurance contracted with, and subsidized through, Washington state's Basic Health Plan.  

I've battled administrators, clerks, and various and sundry other bureaucrats in hospitals and clinics both public and private in various states.  I've fought with insurance agents and HMO supervisors since HMOs were invented.  I've tested the facilities and ERs and pleaded with government agencies up and down the west coast and in Hawaii.  I have a healthcare corporation in Seattle who have my name highlighted in their computers with a note not to talk to me because I'm "too mean," a fact which, coming from a corporation that routinely denies life-saving treatment to people, does give me a little pause.

In any case, my point being that there's not a whole lot about being sick and struggling in the US system that I don't have at least some experience with.

Currently I'm back in California, my last marriage having crumbled under the weight of my last surgery, subsequent 4 year illness and lengthy, debilitating  medical treatments, and the financial devastation that all of that entailed.  The stress was too much and the fallout from that breakup has been consuming most of my time.

I couldn't afford to stay in Washington with no source of income.  I had to file for bankruptcy and sell my house.  I relocated back to my home state of California and had to get my parents settled near my brother and his family.  Eventually, Washington caught on that I'd moved.  They cancelled me.  California has no similar health plan.

As I type this, my step-dad is in a nursing home following a fall on Christmas, my mom is in the hospital with swine flu, my son is recovering from a bout with mono, and I'm a bit worried about needing a mammogram.  You see, I'd gotten one in Washington before my departure, but the letter telling me there was something wrong with it didn't arrive till a week after my notice of cancellation did.  I'm HOPING it was just one of those blurred imaging problems -- I don't feel any lumps -- but the worry niggles at me.

So this is the back drop from which I, personally, am viewing the current healthcare debate.  As you might imagine, given all this, the healthcare bill interests me, to say the least.

I'd been rather busy in the months leading up to the Senate vote, and only cursorily following the blogs.  Like most of you, I was not happy about the public option being dropped.  There were bits of the bill that I was rooting for or against.  But all that said, I was HUGELY relieved when the senate passed the bill on Christmas Eve.  I almost wept.  I popped into my blog home here on ET to share the moment with some politically like-minded allies.

I don't know if you can imagine how dismayed I was to find this historic event was being met with scorn and derision here.  I went looking through the comments and then on to other blogs to see what was going on and was APPALLED to find my allies, in some cases my friends, and activists I like and respect advocating that we "kill the bill."  

I was baffled -- maybe there was something I'd missed.  I read all the arguments and links.  People I generally respected were calling the bill an abomination, a corporate giveaway, worse than the status quo.  I went on an obsessive research binge.  Maybe there was something in it I hadn't heard about -- some massive betrayal that would make defeating healthcare reform and leaving the millions without insurance a worthy goal.  What was in there that could be worse than the status quo?

After reading and researching, I can answer that question with confidence -- NOTHING.  There's NOTHING in this bill that makes passing it worse than killing it.  Killing it, if accomplished, would be the most boneheaded, self-destructive, devastating political act I'll have witnessed in my lifetime.  And that INCLUDES Nader voters who insisted Bush and Gore were the same.

Sorry.  I lost my head for a minute. I'll try to restrain myself, to be reasonable.  I know this post is overly-long already, but I'd like to address some of the arguments I've been reading about.  I realize that most of them have not been discussed thoroughly here on ET and don't expect you to know all the details of our system, but I feel the narrative on this issue has spun wildly out of control.  

Even here, my friends are saying things like "I don't know what to think.  I know it'll help you, so I think I want it, but it sounds so bad.  People we respect are saying it's worse than nothing."  Even here, I'm seeing comments bashing the bill and a narrative becoming set that it's a massive betrayal and won't help anyone.

I cannot even describe how angry this makes me.

But I'm trying to be patient and to keep my temper.  I'm attempting to bear in mind that the people advocating to kill the bill from the left are most likely well-intentioned.  I'm telling myself that it's misplaced passion combined with political naivete.  That's the only conclusion I can come up with, because let me tell you, in reading through a lot of the arguments about HCR, I have never heard more misinformed opinions, stated with more conviction, than I've read the past few weeks.

Let's start with the what the bill does.  The aspect that would most directly affect me is the medicaid expansion.  I've read REPEATEDLY in recent weeks statements along the lines of "sure, it helps the poor, but they qualify for medicaid already."  Two problems with this -- first, if I read any more dismissive comments about helping 'the poor,' my head is gonna explode and, second, it's wrong.  The benefits of the proposed medicaid expansion are huge.  

While people are correct that medicaid is the current government program for poor people, they're wrong in assuming that it helps anyone who's poor.  Currently, one can only qualify for medicaid if one is both poor AND either disabled, blind, or a single parent of a dependent minor, in which case the qualifications and benefits vary from state to state.  I might add that many states, such as here in California, judge whether or not you're disabled based on the Federal disability SSI and SSDI guidelines.  

It's not enough to be unemployable, have doctors say you're disabled, or have insurance companies refuse you due to your shoddy condition, all of which would make me a shoo-in.   Getting the government to acknowledge you as disabled is a lengthy, difficult, and usually adversarial and traumatic process.  I've heard tell that there was a golden era, usually cited as being some time in the 70's, when 'anyone' could get on disability.  If there ever WAS such a time, it's long past.

The senate bill extends medicaid nationwide, based solely on income.  All states will have to accept anyone who's income is up to 133% of the federal poverty level.  Currently, that would mean any individual making under around $14,500 a year, or $29,500 for a family of 4.  States will be reimbursed and will have the discretion to cover people with a higher income.  The house version was actually better in this case, with the required coverage extending to 150% of the guideline.  The bill would immediately extend this coverage to those with pre-existing conditions, give states the option of extending it to everyone else next year, and requires it in 3 years.

Other benefits that are slated to start immediately include prohibitions on rescissions, which is the currently-common practice of rescinding current insurance when a person gets sick;  extends benefits to anyone denied for pre-existing conditions; tax breaks for small businesses; lifts lifetime limits on coverage and restricts annual coverage limits;  covers preventive care without it applying to deductibles;  extends coverage to children through their parents' plans up to age 26;  monitors costs and gives consumers rebates for excessive charges;  helps cover early retirees;  shrinks the Medicare D 'donut hole' in prescription coverage for seniors by $500 and reduces the cost of certain drugs;  stops some cuts to Medicare that are scheduled to take effect this year;  and expands student loans for healthcare workers.

Things that are scheduled to phase in are bonuses in Medicare payments, eliminating cost-sharing for preventive services,  funding for public health clinics, forming insurance exchanges, limiting executive compensation, monitoring/limiting insurance profit;  and providing premium tax credits for individuals making up to 400% of the federal poverty limit.

This doesn't nearly cover everything in the bill -- it's a massive piece of legislation.  But the upshot is that it will extend coverage to millions of people who currently don't have access to it and it will impose regulations and price controls on an industry that currently has none.

I keep hearing it argued that we need health CARE, not insurance COVERAGE and, while I agree that this is the goal, not to mention a catchy talking point, I think it ignores current conditions.  Almost all of the healthcare system in the US, almost all of the infrastructure, is run privately.  There is very, very little by way of public hospitals or clinics and even much of that is run by, or in conjunction with, the private sector.  

The fact of the matter is, is that even a lot of medicare, medicaid, and military coverage is outsourced to managed care plans overseen by none other than the evil insurance empire.  I agree it sucks, but these are the kinds of nuts and bolts changes that our 'friends' on the hard-working right have spent the last few decades implementing in their quest to shrink government.

In reality, if we kill the insurance industry, we'd pretty much have to build from scratch.  I see this bill as a step in co-opting some of their resources WHILE we're funding healthcare workers and building public clinics, which the bill provides.  Unlike the "pharma giveaway" that was medicare part D, extending prescription drug coverage to seniors, this bill contains oversight, regulations, and price controls.  Medicare part D is largely reviled because it had none of those and simply funneled taxpayer money into private hands.  The senate bill addresses many of those issues.

I see most of these issues as being very cut and dried -- it's an unequivocal good to provide coverage for tens of millions of people.  It's an unequivocal good to fund education, build clinics, and provide jobs, working towards actually HAVING a public infrastructure.  It's definitely a step in the right direction to impose regulations on insurance companies, to limit their profits, and to outlaw the worst of their depredations.

There are other, more controversial, parts that are more open to debate and that seem to be the source of a lot of anxiety.  These are the mandates and the excise tax on so-called 'cadillac plans.'  I can't state with any authority that these are definitely "good" or that people absolutely have nothing to worry about.  But I do have some thoughts on the matter, which may or may not help.

I hear people's fears about being forced to buy 'junk insurance.'  There currently is such a thing in the US -- policies that cost a lot and cover little, sometimes only emergency services and often with deductibles that average people never reach in a year, then with catastrophic caps that are quickly exceeded if you do have a medical issue.  There's also the concern that we'd be mandated to give our money to private companies or face punitive fines.  

This is the scenario I keep reading -- that the entire bill is a corporate giveaway that's forcing us to be customers to a predatory industry in exchange for junk policies that do nothing for us and we still go bankrupt and die.  It's usually added that Obama is a sellout, bowing to his corporate masters, and that the Dems will now be reviled and lose elections for the rest of eternity.  Sometimes it's argued that either this was Obama's plan all along, or that he's too inept or... let's say 'unmotivated' to push for the public option or anything better.

My response to these concerns are, first, the bill pretty much regulates these sorts of 'junk insurance' policies and already addresses many of the problems with them -- it limits deductibles, provides preventive care with no deductibles, limits premiums to a percentage of income, and limits annual costs to a percentage of income.  There's also tax credits to go towards these costs for people making under a certain amount of money.  From what I can tell, the new regulations will probably significantly lower most people's existing premiums.

As far as the mandate, it, and the penalties, don't start for several years.  The first year the penalty, for the year, is $95 and eventually maxes out at $750 a few years after that.  The penalty is waived or reduced if you can't afford it.  That doesn't seem excessively punitive to me.  I don't like that we don't have a public option and must choose between private options, but the bill seems to guarantee affordability.  

Having had the personal experience in Washington state with a similar plan, I would welcome such a thing -- I could choose between several private plans, contracted with the state.  I picked the lowest premium plan with the least benefits -- it cost me $17 per month and saved my life.  I went through catastrophic treatments and never paid more than $500 in a calendar year for hundreds of thousands of dollars worth of hospitalizations.  I know from experience that government regulated private insurance can work.

What I like about the mandate is that it establishes the government's acknowledgement that EVERYONE should have healthcare.  That's a huge step in this country.  It makes everyone invested.  And IF the companies can't control costs and can't provide the care to the WHOLE POPULACE, not just to a SEGMENT, then the government will be in a position to set up it's own public care.  It builds an excellent foundation for future improvements.

RIGHT NOW, the industry is completely unregulated and profit unrestricted.  RIGHT NOW there is a huge portion of the population who does not want government interfering in healthcare.  RIGHT NOW the MAJORITY of our public servants think healthcare is a private matter and not the government's concern.  

When I hear arguments from the LEFT that we have no guarantee the government can control the insurance industry, I don't know what to think.  Aren't we the ones arguing FOR government as a tool for good?  Isn't it our stance that government can regulate industry, run correctly, and help its people?  

Because it seems to me that if we don't trust them enough to do the things the bill intends -- if they can't rein in costs, if they can't provide affordable healthcare and stop us from dying and going bankrupt over medical emergencies, then it seems to me that we may as well abandon the notion that a 'public option' will make anything any different.  If one is to think they're powerless to enforce what's in the bill, then what makes us think a public option would be affordable or well run or make any difference whatsoever?

At some point politics is a leap of faith -- the outcome will determine how this is viewed.  If the federal government is so powerless and/or corrupt that it can't regulate premiums and enforce annual costs, then including their own plan at this beginning stage isn't going to make a difference.  If, however, they do get healthcare for a vast majority of the populace as the bill provides for, then it will go a long way to restoring the people's faith in government as a force for good.  

Killing THIS bill, the bill that's gotten further than any bill in my lifetime, the bill that will help millions of people and save thousands of lives, the bill that regulates one of the most powerful industries on the planet restricts their profits, killing this bill will kill all hope of healthcare in our lifetimes.  

If you think there'll be a do-over, you haven't been paying attention.  Defeat will not galvanize public support -- it will reinforce the negative opinion of an already-scared populace.  Defeat will not encourage politicians who are wavering, it will scare them worse than the Clinton debacle and reinforce their belief that it's something that's politically impossible.  Defeat will mar the current administration's chance of accomplishing ANYTHING and taint whatever else they try to do.  

Passing the bill will save lives and stops people from having their lives ruined.  Just in my circle of acquaintance, MOST of the uninsured people I know would be eligible for medicaid.  Just in my family alone -- THIS YEAR -- it would save my parents at least a thousand dollars, it would let my son get back on his father's insurance, and it would cover me.  When the cost restrictions in the bill are in place, everyone I know WITH insurance who I've discussed it with would have lower premiums than they're currently paying.  Me, my family, and everyone I know can't be THAT outside of the norm.  Surely we're not the only ones.

Screaming NOW, before we've implemented the bill, before we have ANY legislation whatsoever, that the dems are corrupt, weak sellouts and advocating killing the bill does no one any good at all and doesn't further the cause in any way.  It doesn't move the Overton Window.  It doesn't help the poor.  It doesn't save anyone any money.  It doesn't save anyone's life.  

I still haven't changed my opinion about the insurance industry.  I still believe what I wrote in 2004.  I still hate them and want to see profit eliminated from our system.  But I see this bill as a huge step towards that goal.  It's a good start and I, for one, intend to keep working and fighting and going forward.  Just as soon as I get that mammogram.

Display:
Sorry for the length of this, and the fact that it may or may not be coherent.  The fact is I promised Jerome I'd write this and post it today, and it's gotten so late I'm too tired to edit or reconsider.  I just hit the button.  I won't be around long -- I need some sleep -- but I promise to respond to comments in the morning.

Maybe we can eventually make language a complete impediment to understanding. -Hobbes
by Izzy (izzy at eurotrib dot com) on Mon Jan 25th, 2010 at 05:36:53 AM EST
I'm glad you wrote it. It's quite convincing!

In the long run, we're all dead. John Maynard Keynes
by Jerome a Paris (etg@eurotrib.com) on Mon Jan 25th, 2010 at 06:13:00 AM EST
[ Parent ]
Are you cross-posting this in Green and Orange?

En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma
by Migeru (migeru at eurotrib dot com) on Mon Jan 25th, 2010 at 06:18:07 AM EST
[ Parent ]
And sending a copy to prominent House Democrats who intend to kill the Senate bill?

USA Today: Pelosi: House lacks votes to pass Senate version of health bill (January 21)

En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma

by Migeru (migeru at eurotrib dot com) on Mon Jan 25th, 2010 at 09:05:22 AM EST
[ Parent ]
Please clarify what you expect Congress to accomplish by "killing" or not killing the Senate bill.

The procedure at this point toward enrollment, then enactment is to join, to edit, two documents, House and Senate bills, by eliminating conflicting provisional language. Both chambers would vote to adopt the conference bill. Sometimes the chambers effect "reconciliation" prior to conference committe per se, so permiting the House majority leader(s) to evoke a Rules Committee motion adopting a "senate version" as delivered to the House for passage prior to pro forma conference committee deliberation.

While news describing the language of the two bills as being 90% identical is accurate, the conflicting language signified by the proportion of provisional differences is not trivial.

In this instance, Pelosi is telegraphing the caucus' position to reject some unstated number of provisions stipulated in the Senate's version and approved by the conference committee.


Diversity is the key to economic and political evolution.

by Cat on Mon Jan 25th, 2010 at 12:59:12 PM EST
[ Parent ]
I think Congress accomplishes nothing by killing the bill, and accomplishes some measure of positive reform by approving the senate bill as is.

In fact, by killing the bill Congress accomplishes worse than nothing: they ensure that at least another 16 years will pass before it is attempted again.

En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma

by Migeru (migeru at eurotrib dot com) on Mon Jan 25th, 2010 at 01:14:02 PM EST
[ Parent ]
Both chambers would vote to adopt the conference bill.

Do you mean vote to adopt or vote on whether to adopt?

Because I believe there would be a filibuster in the Senate if the Senate were asked to vote again, even on the bill they already passed. (Because as of last Tuesday, they is a different they).

En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma

by Migeru (migeru at eurotrib dot com) on Mon Jan 25th, 2010 at 01:19:57 PM EST
[ Parent ]
Right.  You can't get a conference report through, because it'd be subject to the filibuster again.

The only way they're going to get a bill is if the House votes to pass the Senate bill.

Be nice to America. Or we'll bring democracy to your country.

by Drew J Jones (pedobear@pennstatefootball.com) on Mon Jan 25th, 2010 at 03:06:50 PM EST
[ Parent ]

credit: ProPublica

  1. House passes H.R. 3962 EH, "Affordable Health Care for America Act"
  2. Senate passes H.R. 3590 EAS, H.R. 3590 EH (S. 1720), as amended by "Patient Protection and Affordable Care Act"

  3. current congressional action

  4. Clerk delivers conference bill to each of the chambers for vote as "merged" (emended).

::

Do you mean vote to adopt or vote on whether to adopt?

I mean vote to adopt the conference bill. If either chamber fails to pass the conference bill, the legislation fails enactment.

Diversity is the key to economic and political evolution.

by Cat on Mon Jan 25th, 2010 at 04:40:43 PM EST
[ Parent ]
But if the House passes the Senate bill with no changes does the diagram change?
by gk (gk (gk quattro due due sette @gmail.com)) on Mon Jan 25th, 2010 at 04:55:43 PM EST
[ Parent ]
But if the House passes the Senate bill with no changes does the diagram change?

No. This is the procedure to reconcile any (subject) related bills introduced in either of the chambers.

This is why I query to what new "Senate bill" Mig believes Pelosi refers. I checked the senate calendar. There were only two actions (votes) all of last week neither of which concern healthcare insurance reform.

Mig: "Because I believe there would be a filibuster in the Senate if the Senate were asked to vote again, even on the bill they already passed."

The Senate has not passed a germane conference bill; neither has the House. The votes AFAIK are not yet scheduled. Each chamber votes independently to pass the same conference bill.

Mig: "(Because as of last Tuesday, they is a different they)."

I do not understand this statement.

Diversity is the key to economic and political evolution.

by Cat on Mon Jan 25th, 2010 at 05:21:31 PM EST
[ Parent ]
I'm fairly sure your chart only applies if the bills are not identical.  The purpose of a conference report is, after all, to make the bills identical.

Unless there's a rule everybody else is missing, the House can pass the Senate bill, and send it to Obama's desk.

Be nice to America. Or we'll bring democracy to your country.

by Drew J Jones (pedobear@pennstatefootball.com) on Mon Jan 25th, 2010 at 06:40:00 PM EST
[ Parent ]
That was my understanding.

En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma
by Migeru (migeru at eurotrib dot com) on Mon Jan 25th, 2010 at 06:56:45 PM EST
[ Parent ]
Sometimes the chambers effect "reconciliation" prior to conference committee per se, so permiting the House majority leader(s) to evoke a Rules Committee motion adopting a "senate version" as delivered to the House for passage prior to pro forma conference committee deliberation.

emphasis added

Yes, conference is to make the bills identical. Greater than "90%" advertised. You know, all summer the House developed H.R. 3200. This fall Baucus released his outline to Finance Committee, Dingell introduce a conforming H.R. 3962 with first cuts into "public option" provisions. House made further emendments to H.R. 3962 during and after the weeks finance committee hearings were broadcast by CSPAN. By the time Reid began the marathon amendment process, MSM was currying factional acrimony over Hyde Amendment funding prohibition, rather than, say, price discrimination allowed in the Baucus bill but prohibited in the House bill.

Remember "the trigger"?

The Rules Committee could deliver the Baucus bill to the floor for a vote, but Pelosi hasn't  support for a legislative dive. Like I said the differences are few but not trivial and bear on restricting Medicaid eligibility, premium subsidy eligibility, tax benefits, and states' establishment of "public option" plans much less committing matching fed funding to expand existing community-rated plans.

Yes, 133% PL more generous than, say, 50% PL Medicaid eligibility in MD for adults. But the Baucus bill minima reams H.R. 3296 financial support for HH incomes greater than that. A whole hell of alot of uninsured people treading the other bottom deciles. Who fights for them? Party leaderships sez no one.

2009-2010 HHS Poverty Guidelines

And when this thing passes "as is", don't expect improvements, corrections, repeals, or finesse anytime soon thereafter.

Obama will ask to freeze a part of govt spending for 3 years beginning in 2011


Diversity is the key to economic and political evolution.

by Cat on Mon Jan 25th, 2010 at 11:18:42 PM EST
[ Parent ]
when this thing passes "as is", don't expect improvements, corrections, repeals, or finesse anytime soon thereafter

And if it doesn't pass "as is" expect it not to pass at all, followed by noimprovements, corrections, repeals, or finesse anytime soon thereafter.

So, what would you rather have 15 years from now? The current system, or the Senate Bill?

Oh, by the way, on the no improvements hereafter point... Politico has Harry Reid, Nancy Pelosi work to save health care reform

Struggling to salvage health reform, Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi have begun considering a list of changes to the Senate bill in hopes of making it acceptable to liberal House members, according to sources familiar with the situation.

The changes could be included in separate legislation that, if passed, would pave the way for House approval of the Senate bill -- a move that would preserve President Barack Obama's vision of a sweeping health reform plan.

But the move comes with political risk, because it would open Democrats up to charges that they pressed ahead with roughly the same health care bill that voters appeared to reject in the Massachusetts Senate race Tuesday. Republican Scott Brown won on a pledge to try to block Obama-style health reform.

I guess the game here is to pass the Senate Bill in the House and then continue to work on separate legislation. And the point one should not forget is that once an entitlement is given it is exceedingly hard to take away.

En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma
by Migeru (migeru at eurotrib dot com) on Tue Jan 26th, 2010 at 03:58:18 AM EST
[ Parent ]
And the point one should not forget is that once an entitlement is given it is exceedingly hard to take away.

The worrying point is that some parts of the bill only kick in after several years. It might be easier to take away an entitlement that has only been promised, but not actually given.

by gk (gk (gk quattro due due sette @gmail.com)) on Tue Jan 26th, 2010 at 04:32:17 AM EST
[ Parent ]
Why does the US congress always do this sunset provision, gradual kick-in, and other assorted nonsense?

En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma
by Migeru (migeru at eurotrib dot com) on Tue Jan 26th, 2010 at 05:24:04 AM EST
[ Parent ]
Two words: Enron accounting.

Sunset clauses mean that the accountants can pretend that some measure will be a temporary rather than recurring expense. (To be fair to Enron, this is not actually Enron accounting - it's WorldCom accounting.)

Gradual kick-ins mean that costs will only come into effect some way through the accountants' ten-year forecasts. Which, of course, permits a politician to say "it will cost only N million per year over the next ten years," when the true story is that "it will cost 0 million per year for the next three years, N million per year for the four years following that, and 2N million per year after that until the heat death of the universe."

Krugman had a nice deconstruction of these mechanics when he critiqued the Bush tax cuts back in 2001, but damned if I can find it.

- Jake

Friends come and go. Enemies accumulate.

by JakeS (JangoSierra 'at' gmail 'dot' com) on Tue Jan 26th, 2010 at 07:35:10 AM EST
[ Parent ]
Mig: "(Because as of last Tuesday, they is a different they)."

I do not understand this statement.

A certain Senate composition passed the Senate Bill at the end of last month. Last Tuesday a guy who ran on a platform to defeat health care including the Senate Bill if it came back for a revote, presumably, and who called himself "41" in reference to the 60 votes needed to stop a filibuster, won a Senate special election.

So, the Senate who would have to pass the conference bill is a different they from the they that passed the Senate Bill even though both theys are the Senate.

En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma

by Migeru (migeru at eurotrib dot com) on Mon Jan 25th, 2010 at 06:59:44 PM EST
[ Parent ]
What's the difference? -- see Results.org for example.

"Patient Protection and Affordable Care Act" (H.R.3590) "Senate bill" or "Baucus bill" is not the more desirable implementation of the two versions. It is the most parsimonious version under consideration. Not mentioned here is the chambers' different treatments of states' insurance regulation and establishment of state "public option" plans and/or insurance exchanges; as well as insurers' premium constraints and "individual responsibility tax credit" eligibility.

Normally, a conference committee is convened to hammer out a compromise bill. However, it appears that congressional leaders will forego the formal conference procedure to avoid procedural votes that might give opponents of reform an opportunity to further stall reform. Instead, House and Senate leaders will negotiate informally and when a deal is reached, the House will pass the Senate bill with amendments to reflect the compromise, with the Senate following suit

The purported strategic value of the manoever is nonsensical. On one hand, abrogate committee emendments to "avoid procedural votes;" on the other, allow House floor[?] "amendments to reflect the compromise" --normally produced by formal conference-- to assure House passage, then Senate passage, of the not-conference bill.

Diversity is the key to economic and political evolution.

by Cat on Mon Jan 25th, 2010 at 07:03:46 PM EST
[ Parent ]
"Patient Protection and Affordable Care Act" (H.R.3590) "Senate bill" or "Baucus bill" is not the more desirable implementation of the two versions.

Except that it is the only one that may yet pass:

  • The House bill will not be passed by the Senate with its new teabagger from Massachusetts.
  • A conference bill will not be passed by the Senate with its new teabagger from Massachusetts.
  • The Senate bill might yet be passed by the House as is.

Or we could have a conference bill and the democrats might try to defeat a filibuster.
Or the House could kill the Senate bill and there would be no health reform of any description.


En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma
by Migeru (migeru at eurotrib dot com) on Mon Jan 25th, 2010 at 07:07:55 PM EST
[ Parent ]
Did you ever ask, Why would the "teabagger from Massachusetts" in particular oppose the Baucus bill? But not the House bill.

Did you ever ask, What carve-out a la Nelson might the "teabagger from Massachusetts" negotiate? Since all of Congress awaits his arrival.

Also, "Or we could have a conference bill [i.e. committee emendment of two nearly identical bills] and the democrats might try to defeat a filibuster.
Or the House could kill the Senate bill and there would be no health reform of any description.
" is a vintage of ultimatum the Bush congress employed to terrorize representatives and constituents.

It's so nice to hear democrats repeating right-wing talking points. It goes to show constituents' discipline when none is needed to enforce a Democratic Party majority in both chambers that's willing to abandon any "public option" to avoid a filibuster threat during a FY budget season.

Oh wait.

That would be confrontational, no?

Diversity is the key to economic and political evolution.

by Cat on Mon Jan 25th, 2010 at 09:01:35 PM EST
[ Parent ]
Related news:

Sen. Ben Nelson (D-Neb.) said Monday that he would oppose any health care reform bill with a national insurance exchange, which he described as a dealbreaker....

Before the Massachusetts election, the White House and Democratic leaders were attempting to negotiate a compromise that could win 60 votes in the Senate. And Nelson could have deprived House Democrats from securing what they have increasingly viewed as a must-have -- a national exchange rather than a series of state exchanges.

But for now, Democrats are trying to write a companion bill to the full Senate legislation that would need only 51 votes in the Senate.*

Read more...

Baucus innovation from the alternate universe of not-single-payer financed medical insurance.

---
* ohhh-kaaay, "kill the House Bill" passed as a companion bill to the Senate Bill and block a conference bill of same.

Diversity is the key to economic and political evolution.

by Cat on Tue Jan 26th, 2010 at 12:10:40 AM EST
[ Parent ]
Did you ever ask, Why would the "teabagger from Massachusetts" in particular oppose the Baucus bill? But not the House bill.

He'd oppose both.

En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma

by Migeru (migeru at eurotrib dot com) on Tue Jan 26th, 2010 at 03:59:36 AM EST
[ Parent ]
If you think the Democrats can defeat a filibuster, I say go for it.

However, in the 3 years since they gained a majority of the House and the year since they gained a majority of the Senate they haven't given me the impression that they're willing to force the Republicans to filibuster. So I'm working with that data point as well.

En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma

by Migeru (migeru at eurotrib dot com) on Tue Jan 26th, 2010 at 04:01:31 AM EST
[ Parent ]
Time to tell Olympia Snowe and Susan Collins either vote for HCR or lose Bath Shipworks. They should be able to sell that deal to Maine. But wait---that would be doing politics with a knife in the belly. Knife in the back is more standard operating procedure.

"It is not necessary to have hope in order to persevere."
by ARGeezer (ARGeezer a in a circle eurotrib daught com) on Tue Jan 26th, 2010 at 11:24:39 PM EST
[ Parent ]
What do you mean, "What's the difference?"  The difference is one bill requires 60 votes when the Democrats have 59 and the other doesn't require the Senate to vote again.  That's a pretty enormous difference.

It would, indeed, be a nonsensical strategy if you were reading something that was up-to-speed with the makeup of the Senate.  But that seems to have been written prior to Brown's election.  Before Brown, it wasn't nonsensical.

The strategy now is for the House to pass the Senate bill, sending it to Obama, and to amend it via reconciliation.

Be nice to America. Or we'll bring democracy to your country.

by Drew J Jones (pedobear@pennstatefootball.com) on Tue Jan 26th, 2010 at 07:53:34 AM EST
[ Parent ]
Send a copy to Marrion Berry and Vic Snyder of Arkansas, two Blue Dogs. Both are retiring and thus no longer beholden to contributors. They could do some good on the way out. We can hope.

"It is not necessary to have hope in order to persevere."
by ARGeezer (ARGeezer a in a circle eurotrib daught com) on Mon Jan 25th, 2010 at 01:34:24 PM EST
[ Parent ]
Thanks, geezer, and feel free to forward it to anyone you feel should read it.

Maybe we can eventually make language a complete impediment to understanding. -Hobbes
by Izzy (izzy at eurotrib dot com) on Mon Jan 25th, 2010 at 05:36:53 PM EST
[ Parent ]
to post it on dK. She's thinking about it. Hopefully she'll post it directly under her own name.

In the long run, we're all dead. John Maynard Keynes
by Jerome a Paris (etg@eurotrib.com) on Mon Jan 25th, 2010 at 01:16:52 PM EST
[ Parent ]
I'd advocate posting it under your name.

Otherwise it's simply going to be buried under the nonsense.

Be nice to America. Or we'll bring democracy to your country.

by Drew J Jones (pedobear@pennstatefootball.com) on Mon Jan 25th, 2010 at 03:14:32 PM EST
[ Parent ]
http://www.dailykos.com/storyonly/2010/1/25/830118/-An-overly-long-rant-about-HCR

Go rec it!

In the long run, we're all dead. John Maynard Keynes

by Jerome a Paris (etg@eurotrib.com) on Mon Jan 25th, 2010 at 04:41:53 PM EST
[ Parent ]
Only 21 comments. You've got to be kidding me.

En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma
by Migeru (migeru at eurotrib dot com) on Mon Jan 25th, 2010 at 06:55:48 PM EST
[ Parent ]
And numerous replies mindlessly chanting, "Fix it, then pass it."

Be nice to America. Or we'll bring democracy to your country.
by Drew J Jones (pedobear@pennstatefootball.com) on Tue Jan 26th, 2010 at 07:59:43 AM EST
[ Parent ]
They distil even that down to a talking point?

En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma
by Migeru (migeru at eurotrib dot com) on Tue Jan 26th, 2010 at 08:13:42 AM EST
[ Parent ]
The general rule in mainstream American politics is if you can't fit your idea into three words, you're a fag.

"Restoring America's Honor."

"Lifting America's Workers."

"Testing America's Gullibility."

You see?

Be nice to America. Or we'll bring democracy to your country.

by Drew J Jones (pedobear@pennstatefootball.com) on Tue Jan 26th, 2010 at 08:16:20 AM EST
[ Parent ]
Fix-it'ing, then Pass-it'ing?

En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma
by Migeru (migeru at eurotrib dot com) on Tue Jan 26th, 2010 at 08:20:57 AM EST
[ Parent ]
"Fixing America's Health."

Be nice to America. Or we'll bring democracy to your country.
by Drew J Jones (pedobear@pennstatefootball.com) on Tue Jan 26th, 2010 at 08:21:51 AM EST
[ Parent ]
Cross post this everywhere and hijack every blog that is full of ignorant crap about the Bill.  People need to read this.
by In Wales (inwales aaat eurotrib.com) on Mon Jan 25th, 2010 at 08:56:46 AM EST
[ Parent ]
thanks for this, Izzy. There's no doubt that you know of which you speak!

very well written, impassioned diary.

'The history of public debt is full of irony. It rarely follows our ideas of order and justice.' Thomas Piketty

by melo (melometa4(at)gmail.com) on Mon Jan 25th, 2010 at 01:27:47 PM EST
[ Parent ]
On a personal note, is U.K. citizenship a possibility?

"It is not necessary to have hope in order to persevere."
by ARGeezer (ARGeezer a in a circle eurotrib daught com) on Mon Jan 25th, 2010 at 01:35:28 PM EST
[ Parent ]
Based on what she's said, it looks unlikely. You can pass British citizenship down to somebody born outside the U.K only for one generation.
by gk (gk (gk quattro due due sette @gmail.com)) on Mon Jan 25th, 2010 at 04:28:06 PM EST
[ Parent ]
Actually, my mother is Scottish as well.  When I was younger and looked into it, UK citizenship only passed through the father and I was ineligible.  That has since been changed and, so far as I can tell, I'm eligible now.  I was unaffordable for me before but I may be able to swing it now my house is sold -- it's something I've been planning on looking into.

Maybe we can eventually make language a complete impediment to understanding. -Hobbes
by Izzy (izzy at eurotrib dot com) on Mon Jan 25th, 2010 at 05:39:32 PM EST
[ Parent ]
I didn't realize that Britain was also like that. I knew about Swiss citizenship being passed only through the father, but I guess I must have assumed that a country that let women vote would have been different (if you were born before 1961, it looks like the change dates from only a few months ago.) Do they still have prohibitive fees, even for people who really should have been British citizens from the start?
by gk (gk (gk quattro due due sette @gmail.com)) on Mon Jan 25th, 2010 at 05:57:08 PM EST
[ Parent ]
Not sure - define prohibitive? lol.  Last I looked into it, I think the application fee or filing fee or whatever it was called was 250 euros.  Not sure if that's changed since then.

Maybe we can eventually make language a complete impediment to understanding. -Hobbes
by Izzy (izzy at eurotrib dot com) on Mon Jan 25th, 2010 at 06:10:27 PM EST
[ Parent ]
Hey yea, come and be Scottish. I'm sure I can advise on where the best pubs are. Fab pub in Ullapool.

nb, avoid the wee frees areas if you want to hang out your washing on Sunday

keep to the Fen Causeway

by Helen (lareinagal at yahoo dot co dot uk) on Tue Jan 26th, 2010 at 08:32:26 AM EST
[ Parent ]
Or get your ScottishBritish passport, then enjoy the EU's freedom of movement and settle wherever you damn well please.

En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma
by Migeru (migeru at eurotrib dot com) on Tue Jan 26th, 2010 at 08:34:17 AM EST
[ Parent ]
Well, if part of the point is to get easy access to health care, beware : some countries, and certainly France, only cover "workers and their family". If you come in and never work, getting free health care can be quite difficult.

Un roi sans divertissement est un homme plein de misères
by linca (antonin POINT lucas AROBASE gmail.com) on Tue Jan 26th, 2010 at 10:17:53 AM EST
[ Parent ]
Wow, though I had already come to most of the conclusions about the bills that you did, your diary is inspirational.  Time to tweak my congressmen again.  

I can swear there ain't no heaven but I pray there ain't no hell. _ Blood Sweat & Tears
by Gringo (stargazing camel at aoldotcom) on Mon Jan 25th, 2010 at 11:47:40 PM EST
[ Parent ]
Passing the bill will save lives and stops people from having their lives ruined.  Just in my circle of acquaintance, MOST of the uninsured people I know would be eligible for medicaid.  Just in my family alone -- THIS YEAR -- it would save my parents at least a thousand dollars, it would let my son get back on his father's insurance, and it would cover me.  When the cost restrictions in the bill are in place, everyone I know WITH insurance who I've discussed it with would have lower premiums than they're currently paying.  Me, my family, and everyone I know can't be THAT outside of the norm.  Surely we're not the only ones.


Yes, but what does it do for the middle classes? What does it provide to the pundits? Why can't Obama just pass a super-duper left-wing bill by fiat? You'd think that 90% of the US elected representatives, including Obama, were centre-right to right or something and that "socialist" was a term of abuse.
by Colman (colman at eurotrib.com) on Mon Jan 25th, 2010 at 06:39:00 AM EST
Let's start with the what the bill does.  The aspect that would most directly affect me is the medicaid expansion.  I've read REPEATEDLY in recent weeks statements along the lines of "sure, it helps the poor, but they qualify for medicaid already."  Two problems with this -- first, if I read any more dismissive comments about helping 'the poor,' my head is gonna explode and, second, it's wrong.  The benefits of the proposed medicaid expansion are huge.
I guess the point of the whole exercise is not to help the poor but to help the liberal democratic-activist middle-class?

En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma
by Migeru (migeru at eurotrib dot com) on Mon Jan 25th, 2010 at 09:29:19 AM EST
[ Parent ]
To say nothing of the fact that I suspect there's more money in it for the "activists" in killing the bill than ideological benefit in passing it.

Be nice to America. Or we'll bring democracy to your country.
by Drew J Jones (pedobear@pennstatefootball.com) on Mon Jan 25th, 2010 at 03:21:06 PM EST
[ Parent ]
Wow. That's cynical even by my standards.

Where's the  money coming from?

by Colman (colman at eurotrib.com) on Mon Jan 25th, 2010 at 03:30:10 PM EST
[ Parent ]
Well, I don't think it's too cynical.  It seems quite obvious to me.  Which is more likely to gain attention at dKos -- whatever the little Hamsherites are peddling today or Izzy diary?

Which would your typical American lefty rather watch: The Ed Show ranting and raving about the corporate giveaway that is the Senate bill, or the Ed Show trying to calmly explain a thousand-page bill written in lawyerspeak?

I think it's almost undoubtedly the former in both cases.

Be nice to America. Or we'll bring democracy to your country.

by Drew J Jones (pedobear@pennstatefootball.com) on Mon Jan 25th, 2010 at 03:35:54 PM EST
[ Parent ]
I didn't say it was too cynical. I'm not sure what too cynical looks like anymore.
by Colman (colman at eurotrib.com) on Mon Jan 25th, 2010 at 03:49:38 PM EST
[ Parent ]
Your guess is as good as mine these days.  But I think I'm supposed to be ET's resident optimist.

Be nice to America. Or we'll bring democracy to your country.
by Drew J Jones (pedobear@pennstatefootball.com) on Mon Jan 25th, 2010 at 04:31:51 PM EST
[ Parent ]
You are?  I thought it was me.  In either case, I think optimism is in big trouble.

Maybe we can eventually make language a complete impediment to understanding. -Hobbes
by Izzy (izzy at eurotrib dot com) on Mon Jan 25th, 2010 at 05:40:57 PM EST
[ Parent ]
[Drew's WHEEEEE™ Technology]

En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma
by Migeru (migeru at eurotrib dot com) on Mon Jan 25th, 2010 at 07:02:02 PM EST
[ Parent ]
...adding: The money, of course, coming from ads in both cases.

Be nice to America. Or we'll bring democracy to your country.
by Drew J Jones (pedobear@pennstatefootball.com) on Mon Jan 25th, 2010 at 03:37:06 PM EST
[ Parent ]
Screaming NOW, before we've implemented the bill, before we have ANY legislation whatsoever, that the dems are corrupt, weak sellouts and advocating killing the bill does no one any good at all and doesn't further the cause in any way.  It doesn't move the Overton Window.  It doesn't help the poor.  It doesn't save anyone any money.  It doesn't save anyone's life.

Well said, running off and having tantrums because you havent got everything you want is never a good move, unless it is going to get you what you want.

Sorry you're going to have to continue to fight over this issue.

Any idiot can face a crisis - it's day to day living that wears you out.

by ceebs (ceebs (at) eurotrib (dot) com) on Mon Jan 25th, 2010 at 08:32:51 AM EST
This whole episode illustrates the total incompetence of the Democratic Party. I'm speaking of the fact that they went on Christmas vaction without having a backup plan, for this signature issue, in case they lost the 60th Senate vote over the next few weeks either through the special election or through an unanticipted death.
These guys couldn't run my business!

Hey, Grandma Moses started late!
by LEP on Mon Jan 25th, 2010 at 06:10:48 PM EST
I agree it certainly looks that way, but I'm not sure it actually IS that way.  I suppose time will tell.  I'm withholding judgment for several reasons -- first, having closely followed prior healthcare debates, I realize that it's incredibly difficult to get it passed, even though it seems like such a simple thing and a clear, moral issue.  

I know people are upset that Obama hasn't been more vocal, hasn't 'stood up' and hasn't pushed harder.  And it appears he has not.  HOWEVER, the fact that the legislation has gotten as far as it has argues to the contrary.  Not only that, but it seems to me that this may have been a calculated risk, having absorbed the lessons of the 1993 hcr debate.  

In that case, the legislation met with fierce opposition (which has only grown more powerful since), and was largely brought down by attacking the Clintons personally and Hilary in particular.  She was really the 'face' of that legislation and the attacks on her, personally, did much to discredit it.

So I shudder to think, had Obama really "owned" this legislation, what the debate would turn into.  He's already someone who's been attacked for having a cult of personality.  The way they're doing it, with him appearing hands off, keeps the legislation somewhat immune from this sort of tactic.

 What we're bemoaning as assinine bi-partisanship, may be actually a way of getting other politicians invested in the issue, and I don't mean Republicans.  As it stands, it's not JUST Obama who is all tied up in this.  A ton of people have invested a ton of time -- that makes it more difficult to axe.  At least that's my current operating theory.  And fondest hope.

Maybe we can eventually make language a complete impediment to understanding. -Hobbes

by Izzy (izzy at eurotrib dot com) on Mon Jan 25th, 2010 at 06:24:36 PM EST
[ Parent ]
I heard a Princeton professor on All Things Considered complaining that Obama did not have a pedagogical style of speaking and that that was a problem. What he did have was either soaring oratory or wonky seminar type presentations suitable for intellectuals. That seemed to make sense. I think of FDR in the context of pedagogy, especially the Fireside Chats, and, for sure, Obama is no FDR. I think he could be effective in that mode and can only wonder why he has not done so. The professor said he had two slides that showed what was in the bill and what it did, suitable for general audiences.

"It is not necessary to have hope in order to persevere."
by ARGeezer (ARGeezer a in a circle eurotrib daught com) on Tue Jan 26th, 2010 at 11:40:52 PM EST
[ Parent ]
I think there's definitely some truth to the idea of getting others "invested" in the issue.  That was a failure during the Clinton administration.  Getting people invested and hammering home the fact that they're writing what would potentially be among the three or so most important pieces of legislation in the last hundred years is likely a fairly powerful motive.

The downside is that it means Congress does what Congress does "best": Drag its feet.  And I think it's easier to preserve the investment with senators than it is with the House members, who play a much smaller role and face reelection every two years.

I think the basic strategy is right, but I also think Obama should've been a bit more involved in overseeing and directly the thing.

Maybe not.  I don't know.  We tend to go back and compare this effort with Clinton's, but something to keep in mind is that every Democrat (plus Nixon) in the modern era has tried this and come up short.

Even Johnson.  And, yes, even FDR.

People tend to forget that sometimes.

Be nice to America. Or we'll bring democracy to your country.

by Drew J Jones (pedobear@pennstatefootball.com) on Wed Jan 27th, 2010 at 09:18:06 AM EST
[ Parent ]
Do you have any idea how serious Nixon was about this? The tapes from the previous year don't give a very good impression
President Nixon: "Say that I ... I ... I'd tell him I have doubts about it, but I think that it's, uh, now let me ask you, now you give me your judgment. You know I'm not too keen on any of these damn medical programs."

Ehrlichman: "This, uh, let me, let me tell you how I am ..."

President Nixon: [Unclear.]

Ehrlichman: "This ... this is a ..."

President Nixon: "I don't [unclear] ..."

Ehrlichman: "... private enterprise one.

[... ]

All the incentives are toward less medical care, because ..."

President Nixon: [Unclear.]

Ehrlichman: "... the less care they give them, the more money they make."

President Nixon: "Fine." [Unclear.]

Ehrlichman: [Unclear] "... and the incentives run the right way."

President Nixon: "Not bad."

by gk (gk (gk quattro due due sette @gmail.com)) on Wed Jan 27th, 2010 at 09:33:10 AM EST
[ Parent ]
I don't, honestly.  I'd never seen those tapes before.

Be nice to America. Or we'll bring democracy to your country.
by Drew J Jones (pedobear@pennstatefootball.com) on Wed Jan 27th, 2010 at 12:00:33 PM EST
[ Parent ]
Thank you Izzy for spelling out your position in a way understandable to me, as I am not familiar with the US system. Most of the debate has not been.

Sweden's finest (and perhaps only) collaborative, leftist e-newspaper Synapze.se
by A swedish kind of death on Tue Jan 26th, 2010 at 09:36:23 AM EST
Wow.
I thought I knew something about the underside of the American health care system, but--now I know a lot more.
You have totally changed my mind about the bill.

Thanks. I needed that.

Capitalism searches out the darkest corners of human potential, and mainlines them.

by geezer in Paris (risico at wanadoo(flypoop)fr) on Fri Jan 29th, 2010 at 07:02:18 AM EST


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